Acupuncture For Insomnia

III

Acupuncture for Insomnia Sleep and Dreams in Chinese Medicine

Hamid Montakab, MD Academy of Chinese Healing Arts Winterthur Private Practice Savièse Switzerland

With the collaboration of Solange Montakab-Pont

40 illustrations

Thieme Stuttgart · New York

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ISBN 978–3–13–164401–5

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This book, including all parts thereof, is legally protected by copyright. Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation, without the publisher’s consent, is illegal and liable to prosecution. This applies in particular to photostat reproduction, copying, mimeographing, preparation of microfilms, and electronic data processing and storage.

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Dedicated to the memory of my parents.

Dreaming when Dawnʼs Left Hand was in the sky I heard a Voice within the Tavern cry, “Awake, my Little ones, and fill the Cup Before Life's Liquor in its Cup be dry.” The Rubaiyat of Omar Khayyam (11th century Persian Sufi mystic)

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Hamid 2009

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Acknowledgements

In the realization of this book I am greatly indebted to Master Jeffrey Yuen for having shared with us his profound understanding and knowledge of Chinese Medicine and Daoist philosophy over the past 11 years and for allowing me to share these gems with the readers. His knowledge has given substance to many of the Chinese theories, helping us to understand and integrate them into modern acupuncture practice. I am grateful to Dr. Michel Frey and Roland Solere for their personal contributions, and especially to Dr. Kamran Ghaffari for his invaluable support in reading and commenting my text.

I would like to thank Dr. Gerald Langel, coauthor of the Insomnia study project, and Professor K. von Berlepsch for his support and counsel. I would like to thank Angelika Findgott of Thieme Publishers for supporting this book project and her and Deborah Cecere for their painstaking and expert editing of the manuscript. Finally I would like to express my deep gratitude to my wife Solange—for her input on dream work and, above all, for her unwavering and patient support of my various projects.

VIII

Foreword

Everyone, at some point in their life, suffers from a sleepless night. Unfortunately, some are haunted by what appears to be endless nights without sleep. While some may say that the nocturnal life depends heavily on how calm we are and how calm the day was, it does not necessarily provide the solutions for those afflicted. The good news is that Dr. Hamid Montakab has created a clinically proven and extremely eclectic synthesis of medical traditions that has brought hope and sound sleep to his patients. In addition, the shadowless images and the nameless voices expressed in dreams tell us that at the heart of our sleep lies an enduring sense of revelation. Drawing upon dream analysis can provide us with a deeper understanding of life where our psyche or shen-spirit is confronted with the choices, conscious or unconscious, that can further unravel the meaning of our life. From sweet dreams to nightmares, signposts are fashioned for our undertaking. We may find ourselves awake, only to close our eyes again and let our deep inhalation bring us back to the humanness of our plight. Some may choose not to return to sleep and lie awake, tossing and turning with the uncertainties of the glimpses they have broken away from. Dr. Montakab explores this process with his insightful methodology to bring tangible results to those suffering from dream disturbances. Insomnia can also be viewed as a continuous challenge of emptying the heart and mind of its sediment, so a new life as expressed by a new day can makes its way into these domains. For some, the new day never comes and life continues in its standstill defiance. Surrender is the blossoming of the heart and the welcoming of a new tomorrow. The words on these pages will show the reader how the heart and mind can dance ecstatically together in steps toward personal transformation. Hamid Montakab, MD, the inspired author of this book, has taken on the vision and task beyond the current literature available on sleep, insomnia, and dreams. Sharing his vision not only from his understanding of the research from Western medicine, but also weaving the wisdom of Chinese

medicine and the influence of French acupuncture, Dr. Montakab has created a comprehensive approach for delving into the mystery of sleep. Beyond the alpha waves, hormones, circadian rhythms, and wandering hun, Dr. Montakab investigates the significance of sleep to the essence of our spirit. With the integration of these various traditions, the content of this book will provoke the clinician, comfort the patient, and implore the reader to utilize these protocols. Often physicians and clinicians tend to be conservative, fearful of saying things in print that might be challenged by their peers as seemingly “unscientific,” “anecdotal,” or “lacking references.” Dr. Montakab, trained in the scientific inquiry, has yet also trekked into the vast abyss of Chinese medical wisdom—garnered from centuries of empirical practice. I believe he has decided to be brave and to begin sharing his logic with those in both the scientific and clinical community with his synthesis of East and West, so as to open and perhaps stimulate their minds to these other viable and sensible options in the treatment of insomnia. Every now and then a book is written that is not inert matter, mere paper upon which ink has been spread in a specific font, format, and print. Rather, it serves to not only change the way we think but also the way we feel. Not only does it open our minds, it opens our hearts. This book is a product of such endeavors, written and expressed through the intelligence of a clinician who genuinely cares about our ordeal in the struggle to achieve restful and restorative sleep. It points the way to a new perspective in its contribution to the profession of Oriental medicine. Metaphorically, sleep is the preparation for death—the passage that instills letting go and being at peace. Instead of the curiosity enticed by the light, we move into the darkness. Here lays transformation, for the unknown forces us to surrender. Upon awakening, we are resurrected into a new day. We are refreshed and the opportunity to embrace a new day or mindset is here. Paving the way to new possibilities is bestowed upon us each morning. The treatments instructed in this text

Foreword

will serve as an important companion toward that renewal. It is reassuring that Dr. Hamid Montakab is leading the way toward a new healing system that is more clinically effective, more humane, and more cost effective. He continues to demonstrate his brilliance, determination, and altruism in his servitude to humanity in this text.

May this book honor that which has guided the reader through life in that dance we call being asleep. Jeffrey C. Yuen Director of Classical Studies Daoist Traditions (College of Chinese Medical Arts) Asheville, North Carolina USA

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Preface

In my almost 40 years of clinical practice it seems to me that more and more patients have been complaining of sleeping problems. In the early 1990s I designed a study project which was supported by project No. 4034-35871 of the Swiss National Science Foundation (Complementary Medicine). At that time I did a lot of research into sleep and acupuncture and was surprised to find so little literature in Chinese medical texts on sleep and sleep pathologies. Although there are clinical textbooks in Chinese Medicine covering all types of pathologies, not a single one is dedicated specifically to sleep, despite sleep being as indispensible to life as air, water, and food. In an average lifetime of 75 years, we spend over 20 years sleeping and about 6 of those dreaming! In my opinion, such an important aspect of human life deserves at least some recognition. In the 1990s, various statistical data showed that, on average, over 25% of the population in industrialized countries suffered from insomnia. Today this figure is even higher—closer to 40%.

Insomnia affects all age groups including, disturbingly, an increasing number of children. In the past decades, many ancient Chinese medical principles have found explanation and justification in modern nuclear physics and advances in medical neuroendocrinology and genetic science. Throughout this book, I have attempted to draw parallels between the ancient oriental theories and modern day discoveries or theories pertaining to sleeping and dreaming. My main concern has been to keep this text as practical as possible for the acupuncture clinician. At every step, I have suggested the classical and traditional Chinese medical approaches as well as various other possible methodologies, giving ample clinical examples, covering not only insomnia but also a variety of other sleep pathologies. I hope that this work will spark interest in the subject and open the door to further studies and investigations into the fascinating dimension of sleep and dreams. Hamid Montakab Savièse, Switzerland

Foreword

Abbreviations

AASM CPAP CNS DILD DMT EEG GABA MEF MOS MS non-REM OSA

American Academy of Sleep Medicine continuous positive airway pressure central nervous system dream-initiated lucid dream dimethyltryptamine electroencephalograph Gamma-aminobutyric acid (MOS) Energy and Fatigue Module Medical Outcomes Study (MOS) Sleep Module non rapid eye movement obstructive sleep apnea

OSHAS PET PSQI REM RLS SAD SCN SIDS SWS TCM WILD

obstructive sleep apnea–hypopnea syndrome positron emission tomography Pittsburgh Sleep Quality Index rapid eye movement restless legs syndrome seasonal affective disorders suprachiasmatic nucleus sudden infant death syndrome slow-wave sleep Traditional Chinese Medicine wake-initiated lucid dream

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Table of Contents

1

Physiology of Sleep

Western Physiology of Normal Sleep ................. 1 The Functions of Sleep ........................................ Why Do We Sleep? ................................................ Physiological Processes Related to Sleep ............... Restoration/Rejuvenation ................................. Anabolism and Somatic Growth ....................... Development of the Brain/Ontogenesis ............ Memory and Sleep ............................................

1 1 1 1 2 2 2

Normal Sleep ....................................................... Sleep Stages .......................................................... Circadian Rhythm .................................................. Ultradian Rhythm .................................................. Amount of Sleep ................................................... Consequences of Inadequate Sleep ...................... Dreams ................................................................. Dream Theories .....................................................

2 2 4 5 5 6 6 7

Sleep Disorders .................................................... 9 Dyssomnia ............................................................ 9 Parasomnia ......................................................... 10 Secondary to Medical or Psychiatric Conditions ........................................................... 10 Insomnia ............................................................ 11 Causes of Insomnia ............................................. 12 Treatment of Insomnia ........................................ 12

2

Sleep in Chinese Medicine

Yin/Yang ............................................................. 13 Sleep and the Substances: Wei Qi–Xue–Shen ... Movements of Wei Qi: Physical Relaxation ........... Shen: Mental Relaxation ...................................... Shen 神 .......................................................... Yi 意 ................................................................ Gui 鬼 ............................................................. Hun 魂, Po 魄 ................................................. Xue, Shen, and Hun ..............................................

14 14 16 16 17 18 18 19

Sleep and the Zang Fu ....................................... Heart, Sleep, and the Emotions ........................... Hun, the Liver, and Dreaming .............................. Sleep and the Fu ..................................................

21 21 21 22

Sleep and the Extraordinary Vessels ................ Organization of Yang ........................................... Organization of Yin .............................................. Organization of Sleep .......................................... Time ............................................................... Space ..............................................................

22 23 23 24 25 26

3

Insomnia

Diagnosing Insomnia ........................................ 30 Etiology and Treatment of Insomnia ................ Movements of Wei Qi .......................................... Movements of Blood ........................................... Zang Fu Pathologies ............................................ Fire Phase ....................................................... Wood Phase .................................................... Earth Phase ..................................................... Metal Phase .................................................... Water Phase .................................................... Emotions ............................................................. The Five Movements and the Five Wills .......... Management of Emotional Patterns That Disturb Sleep .................................................. Extraordinary Vessels .......................................... Insomnia Due to Seasonal Desynchronization .............................................. Acupuncture Points Affecting Sleep .................... Heart-Shou Shao Yin and Kidney-Zu Shao Yin Channels ......................................................... Pericardium-Shou Jue Yin and Liver-Zu Jue Yin Channels ......................................................... Lung-Shou Tai Yin and Spleen-Zu Tai Yin Channels ......................................................... Large Intestine-Shou Yang Ming and Stomach-Zu Yang Min Channels ...................... Small Intestine-Shou Tai Yang and Bladder-Zu Tai Yang Channels .........................

32 32 35 35 35 37 38 38 38 39 39 40 42 43 44 44 44 45 46 46

Table of Contents

Triple Burner-Shou Shao Yang and Gallbladder-Zu Shao Yang Channels ................ Du Mai-Governing and Ren Mai-Conception Vessels ............................................................ Extra Points for Insomnia .................................... Ear Acupuncture ................................................. Some Classical Acupuncture Point Combinations ..................................................... Qi Gong for Insomnia ........................................... Overview of Treatment Strategies .......................

47 48 48 50 51 51 52

Case Studies ....................................................... 53

4

Other Sleep Pathologies

Somnolence—Shi Shui 嗜睡 ............................... 65 Explanation and Discussion ............................. 65 Patterns and Treatment .................................. 66 Somnambulism/Sleep-walking—Meng You 梦游 67 Explanation ..................................................... 67 Patterns and Treatments ................................ 68 Sleep-talking—Meng Yi 梦呓 ............................. 69 Explanation ..................................................... 69 Patterns and Treatments ................................ 69 Sleep Apnea—Shui Mian Hu Xi Zhan Ting Zong He Zheng 睡眠呼吸暂停综合征 ......................... Explanation ..................................................... Patterns and Treatments ................................ Treatment Strategies ......................................

70 70 71 72

Enuresis and Nocturia—Yi Niao 遗尿 ................. Explanation ..................................................... Patterns and Treatments ................................ Treatment Strategies ......................................

72 72 73 74

Excessive Dreaming—Duo Meng 多梦 .............. 74 Explanation ..................................................... 74 Patterns and Treatments ................................ 75 Nightmares—Meng Yan 梦魘 ............................. 77 Explanation ..................................................... 77 Patterns and Treatments ................................ 78 Night Fright/Night Terror—Ye Jing 夜惊 ............ 79 Explanation ..................................................... 79 Patterns and Treatments ................................ 80

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Dreams of Flying—Meng Fei 梦飞 ...................... 80 Explanation ..................................................... 80 Patterns and Treatments ................................ 81 Dreams of Falling—Meng Zhui 梦坠 .................. 81 Explanation ..................................................... 81 Patterns and Treatments ................................ 82 Sexual Dreams—Meng Jiao 梦交 ....................... 83 Explanation ..................................................... 83 Patterns and Treatments ................................ 83 Circadian Rhythm Desynchronization .............. Jet Lag ................................................................. Explanation ..................................................... Therapeutic Protocols ..................................... Shiftwork ............................................................

5

84 84 84 85 88

Dreams and Their Significance in Chinese Medicine

Modern Western and Ancient Eastern Theories about Dreams .................................................... 89 Greek Mythology ................................................ 89 Middle Eastern Traditions .................................... 89 Hindu Traditions .................................................. 89 Buddhist Tradition ............................................... 90 Chinese Tradition ................................................ 90 Modern Dream Theories in Relation to Chinese Traditional Concepts ........................... Developmental Dreams ...................................... Interacting Dreams ............................................. Transformational Dreams ....................................

94 95 95 96

Dreams as Reality, or Life as a Dream .............. 98 The Significance of Dreams in the Chinese Tradition ............................................................. 99 Common Dream Interpretations and Therapeutic Strategies Based on the Discussions and Commentaries on Sleep and Dreams by Master Yuen ........................... 100 Dreams of Fear/Danger/Threat = Kidneys ......... 101 General Concepts ......................................... 101 Other General Points Indicated in Fear Dreams ........................................................ 101 Common Traditional Chinese Medicine Kidney Patterns Causing Fear Dreams ...................... 101

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Table of Contents

Dreams of Home/Property/Territory/ Boundaries/Valuables = Spleen ......................... General Concepts ......................................... General Points for Spleen Patterns ................ Common Traditional Chinese Medicine Spleen Patterns Causing Loss of Property Dreams ......................................................... Dreams of Control/Direction/Movement/ Navigation = Liver ............................................. General Concepts ......................................... General Points for Liver Patterns ................... Common Traditional Chinese Medicine Liver Patterns Causing Control Dreams ................. Dreams of Vulnerability/Exposure = Lungs ........ General Concepts ......................................... General Points for Lung Patterns .................. Common Traditional Chinese Medicine Lung Patterns Causing Vulnerability Dreams ......... Dreams of Night Terrors/Ghosts = Accumulation of Phlegm ................................... General Concepts ......................................... General Points for Phlegm Patterns .............. Common Traditional Chinese Medicine Dream-Shock Patterns Causing Night Terrors

Appendices 102 102 102

103 103 103 104 104 104 104 105 105 105 105 105 105

The Importance of Reintegrating Dream Interpretation into Chinese Medicine ............ 107

6

Clinical Evaluation

Clinical Study on Acupuncture and Insomnia Patients ............................................................. Methodology .................................................... Protocols for the Subjective Evaluation of Sleep ............................................................. Protocols for the Objective Evaluation of Sleep ............................................................. Results .............................................................. Objective Evaluation by Polysomnography ... Subjective Assessment of Sleep .................... Discussion and Analysis of Results ....................

109 109 110

Appendix 1 ....................................................... Index of Sleep-related Symptoms and Acupuncture Points ........................................... Acupuncture Points Containing the Characters Shen, Ling, and Gui ............................................ Acupuncture Points Containing the Character Shen—神 ....................................... Acupuncture Points Containing the Character Ling (Soul)—靈 .............................. Acupuncture Points Containing the Character Gui (Ghost) 鬼 .............................. Point Combinations for the Treatment of “Possessions” .................................................... Sun Si Miao’s 13 Ghost Points—Treatment for Possessions .............................................. Worsley’s Seven Dragons—for Internal and External Demons ..........................................

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Appendix 2 ....................................................... Working with Dreams, by Solange Montakab-Pont ................................................. Energetic and Physiological Effects of Dreams ......................................................... The Place of Dreams in Modern Psychotherapy .............................................. How to Use Dreams in Psychotherapy .......... Lucid Dreaming ............................................ Dream Analysis ............................................. Integrating Dream Work into an Acupuncture Session ....................................

129

124 127 127 127 128 128 128 129

129 129 130 130 131 131 132

Glossary of Chinese Terms Used in the Book . 134 111 111 111 111 112 112

Other Clinical Studies on Insomnia and Other Sleep Disorders ................................................ 119

Bibliography Chinese Classical Texts .................................... 137 Contemporary Texts ....................................... 137 Personal Communications .............................. 143

Index ................................................................ 144

1

1

Physiology of Sleep

Western Physiology of Normal Sleep Sleep is defined as a natural, regularly recurring condition of rest for the body and mind that has been observed in humans and some animals. Sleep is distinguished from quiet wakefulness by a decreased ability to react to stimuli, and it is more easily reversible than hibernation or coma. Sleep is common to all mammals and birds, and is also seen in many reptiles, amphibians, and fish. In humans, other mammals, and a substantial majority of other animals that have been studied (such as some species of fish, birds, ants, and fruit flies), regular sleep is essential for survival. The purposes and mechanisms of sleep are only partially understood, and are therefore the subject of intense research.

The Functions of Sleep

Sleep deprivation causes mental, emotional, and physical fatigue and is a risk factor for depression (Riemann and Voderholzer 2003). It is unclear why a lack of sleep causes irritability; some relate this to the reduced production of cortisol during deep sleep, which can have a negative effect on the alertness and emotions of a person during the day (Leproult et al. 1997, Balbo et al. 2010). Sleep debt results in diminished abilities to perform high-level cognitive functions. This has led many Japanese companies to provide facilities for their employees so that they can have short sleep breaks of 15–20 minutes, which seems to improve their vigilance and performance. After suffering sleep deprivation, a person will recuperate by increasing the proportion of deep sleep (also known as Stage 4, or N3) and rapid eye movement (REM), or dreaming, sleep. This indicates that both of these stages of sleep are essential for the health of the organism. Deep sleep assists in the physical repair of the body, while REM sleep is responsible for the recovery of the CNS (Friedmann et al. 1977, Gaillard 1990).

Why Do We Sleep? Science has not yet been able to provide a definitive answer to the question of why we need to sleep. Is it to recover from fatigue or to prevent us getting tired? In humans, each sleep cycle lasts 90 to 110 minutes (Swierzewski 2000), and each stage has a distinct physiological function. Sleeping pills, alcohol, or other drugs can suppress certain stages of sleep, resulting in sleep that does not fulfill its physiological functions. In other words, the person wakes up still feeling tired after apparently getting sufficient sleep. Studies on total or selective sleep deprivation, both on humans and on most animals, have demonstrated no somatic changes in the body, only disturbances of the central nervous system (CNS) manifesting as nervous fatigue and reduced intellectual capacity (Horne 1988). This could be due to an accumulation of certain metabolites such as gamma-aminobutyric acid.

Physiological Processes Related to Sleep Restoration/Rejuvenation A study conducted in 2004 analyzed the effects of sleep deprivation on wound healing in male rats. Results showed that wound healing may indeed be delayed in rats deprived of sleep (Gumustekin et al. 2004). Zager et al. (2007) proposes that loss of sleep impairs immune function, and that immune challenge alters sleep. Most species increase their sleeping hours when recovering from trauma or disease. It has also been suggested that species with longer sleep times have higher white blood cell counts (Marks et al. 1995).

2

1 Physiology of Sleep

Anabolism and Somatic Growth Anabolic hormones such as growth hormones are primarily secreted during sleep. Although one study on children did not show any effect on growth (Jenni et al. 2007), another study on adults found that men with a high percentage of slowwave sleep (SWS; N3, Stages 3 and 4, or deep sleep) had a higher level of growth hormone secretion than participants with a lower percentage of SWS (Van Cauter et al. 2000). Sleep, therefore, can be described as an anabolic state that enhances various physiological processes relating to the immune, nervous, muscular, and skeletal systems, for instance. Wakefulness, on the other hand, may be considered to be a catabolic state during which the organism acquires nourishment and reproduces.

fluence of sleep on memory to be related to the functioning of the nerve cell dendrites. These dendrites send information to the cell body, to be organized into new neuronal connections provided that no external information is presented to these dendrites. It could be that we solidify memories and organize knowledge during sleep .

Normal Sleep In mammals and birds, sleep is divided into two broad types: REM and non-REM. Each type has a distinct set of associated physiological, neurological, and psychological features.

Sleep Stages Development of the Brain/Ontogenesis According to Marks et al. (1995) brain development occurs during neonatal REM sleep. REM sleep occupies the majority of infants’ sleep time, and is thus important for brain development. Babies born prematurely spend more time in REM sleep. The muscle inhibition in the presence of brain activation during REM sleep allows for brain development by activating the synapses without any motor consequences. REM sleep (dream) deprivation in infants results in developmental abnormalities later in life, such as behavioral problems, sleep disruption, and decreased brain mass (Mirmiran et al. 1983).

Memory and Sleep Sleep deprivation affects the working memory, which is responsible for high-level cognitive functions such as decision-making, reasoning, and episodic memory. Memory can be affected differently by certain stages of sleep. REM sleep can benefit procedural memory (long-term memory of learned skills), whereas non-REM slow-wave sleep (SWS) can enhance declarative memory (memory of facts as for word-pair retention [Born et al. 2006, Walker 2009]). A Harvard sleep research study (Stickgold et al. 2001, Stickgold 2005) considers the essential in-

The stages of sleep were first described in 1937 by Loomis et al., who separated the different electroencephalograph (EEG) features of sleep into five levels (A to E) representing the stages between wakefulness and deep sleep. In 1957, Dement and Kleitman identified REM sleep as being separate from non-REM sleep. They further reclassified sleep into four non-REM stages and REM. In 1968, Rechtschaffen and Kales standardized this classification in their R & K sleep scoring manual, dividing non-REM sleep into four stages, with SWS comprising Stages 3 and 4. In Stage 3, delta waves made up less than 50% of the total wave patterns, whereas they made up more than 50% in Stage 4. REM sleep was sometimes referred to as Stage 5 sleep. In 2004, the American Academy of Sleep Medicine (AASM) reviewed the sleep stages and made some changes, dividing non-REM sleep into three stages: N1, N2, and N3, the latter comprising the previous Stages 3 and 4, also called SWS, or delta sleep (Table 1.1). Sleep stages and other biophysiological variables of sleep can be evaluated in a sleep laboratory by means of polysomnography, which includes an EEG of brain waves, electrooculography of eye movements, and electromyography of skeletal muscle activity, as well as other parameters such as an electrocardiogram, nasal airflow, pulse oximetry, a sound probe for snoring, and in some cases a gauge to measure nocturnal penile tumescence.

Normal Sleep

Table 1.1 Normal sleep stages, EEG and clinical correlation Sleep stage (AASM) N1 (R & K Stage 0–1)

EEG

Alpha activity

Beta activity

Clinical correlation

Progressive attenuation of alpha waves of 8–13 Hz (common in the awake state) to theta waves 4–7 Hz

●

Drowsiness or somnolence (transition of wakefulness to sleep)

●

Slow rolling eye movements

●

Some loss of muscle tone

●

Loss of most conscious awareness of the external environment

●

Occasional twitches and jerks

●

Occasional hypnagogic hallucinations

N2 is characterized by the appearance of:

●

Decrease of muscular activity

●

Sleep spindles: shortlived 15-Hz activity (fronto-central regions)

●

Absence of conscious awareness of the external environment

●

●

K-complexes: highamplitude, long-duration biphasic activity

Corresponds to superficial sleep with the possible presence of short fragmented mundane thoughts

●

Predominant sleep Stage 45%–55% of total sleep in adults

Delta waves ranging from 0.5–4 Hz:

●

Deep sleep

●

Body immobility

Stage 3: delta activity 20%–50% of the time

●

Manifestations of parasomnia (sleepwalking, sleep-talking, night terrors, and bed-wetting)

EEG desynchronization:

●

REM

●

●

Muscle atonia

●

REM sleep accounts for 20%–25% of total sleep time in human adults

Enhanced beta activity (12–30 Hz)

Theta waves

N2 (R & K Stage 2)

Spindle

Wave type

K-complex

N3 Slow wave sleep (SWS) (R & K Stage 3–4)

Stage 4: delta > 50% Sleep efficacy evaluated by delta activity, combining Stages 3 and 4

Delta waves

Rapid eye movement (REM) or paradoxical sleep

Brief, fragmented rapid alpha rhythm

●

Low-voltage EEG theta and beta acivity as in wakefulness

●

Saw tooth waves (central regions)

3

4

1 Physiology of Sleep

Polysomnography has been used to distinguish the following stages of sleep: Stage N1 (previously classified as Stage 0 and Stage 1): drowsiness or somnolence, which is defined by the transition from wakefulness to sleep. The brain waves evolve from alpha waves in the frequency range of 8–13 Hz (common in the awake state) into theta waves in the frequency range of 4–7 Hz. During Stage N1, the person loses some muscle tone and most conscious awareness of the external environment. Sometimes sudden twitches and jerks can be observed at this stage. Some people also experience hypnagogic hallucinations. Stage N2 (Stage 2 of the R & K standard) is characterized by sleep spindles (i. e., an EEG waveform consisting of short-lived 15-Hz activity, mostly in the fronto-central regions) in the frequency range 12–16 Hz and K-complexes (i.e, an EEG waveform consisting of high-amplitude, long-duration biphasic activity). During this stage, muscular activity decreases, and conscious awareness of the external environment disappears. This stage occupies 45%– 55% of total sleep in adults, and corresponds to superficial sleep, with the possible presence of short, fragmented, mundane thoughts. Stage N3 (deep sleep or SWS, previously known as Stages 3 and 4 of the R & K standard), is characterized by delta waves in the frequency range 0.5– 4 Hz (also known as delta rhythms). Today, the efficacy of sleep is evaluated based on this delta activity. Manifestations termed parasomnia, such as sleep-walking, sleep-talking, night terrors, and bed-wetting, occur in Stage N3. REM (paradoxical) sleep is so called because the EEG shows that the brain is very active while the body is virtually immobile. This is also known as the stage in which dreaming occurs. Muscle atonia at this stage could be a natural necessity to protect the person from self-harm through physically acting out scenes from the vivid dreams that are occurring. REM sleep accounts for 20%–25% of total sleep time in human adults. The criteria for REM sleep include rapid eye movements as well as a rapid low-voltage EEG.

Circadian Rhythm Our biological functions follow a circadian cycle, referred to as chronobiology. This circadian cycle is subject to two synchronizers: internal (the inner clock) and external (the day–night cycle). It would seem logical that the internal clock would follow the external day–night cycle. Surprisingly, however, in studies in which participants were isolated from the outside world and allowed to find their own internal rhythm, there was a discrepancy between the exogenous 24-hour rhythm and the endogenous rhythm. The internal (endogenous) rhythm turned out to be closer to 25 hours, actually a 24.65-hour cycle, which corresponds to the natural solar day–night cycle on the planet Mars rather than to the normal 24-hour (23.56-hour) cycle of the earth’s rotation (Wever 1979, Scheer et al. 2007). The primary circadian clock in mammals is located in the suprachiasmatic nucleus (SCN), in the hypothalamus, referred to as the “master clock.” The retina, containing special photosensitive cells, transmits information about light, specifically the length of day and night, light intensity and wavelength (or color) and light direction, to the hypothalamus. The hypothalamus in turn transmits the information to the pineal gland. The pineal gland secretes melatonin; its peak at night enhances sleep. This “master clock” governs the many aspects of physiology and behavior by controlling the fluctuation of the hormones, neurotransmitters, and chemicals. In the 1990s, Dr. Takahashi’s team identified the first mammalian gene related to circadian rhythms, and discovered that this protein, named the “clock protein,” was not only found in the brain, but actually in every cell (in King et al. 1997). In a more recent study (Takahashi 2010), it was demonstrated that the SCN transforms that information into neural signals that set the body’s temperature. Even small changes in body temperature can send a powerful signal to the clocks in our bodies. The core body temperature, which also presents a rhythmic alternation of about 25 hours and is therefore similar to the sleep and wake cycles is independent of outside temperature changes. It may therefore be suggested that there are two main internal oscillators: the day–night cycle and core body temperature.

Normal Sleep

10:00: Highest alertness 9:00: Highest testosterone secretion 8:00: Likeliest time for bowel movement 7:30: Melatonin secretion stops 6:45: Sharpest rise in blood pressure

Midday 12:00 14:30: Best coordination 15:30: Fastest reaction time Human biological clock

4:30: Lowest body temperature

17:00: Greatest cardiovascular efficiency and muscular strength 18:30: Highest blood pressure 19:00: Highest body temperature 21:00: Melatonin secretion starts

2:00: Deepest sleep

24:00 Midnight

Fig. 1.1 The human clock by Yassine Mrabet: the circadian patterns of someone who rises early in the morning, eats lunch around noon, and goes to sleep around 10 p.m. The circadian rhythms tend to be synchronized with the cycles

The inner synchronizer, the circadian clock, besides being closely related to the fluctuations of temperature, seems to work in tandem with adenosine, a neurotransmitter that inhibits many of the bodily processes associated with wakefulness. Adenosine, produced over the course of the day, reaches high levels at night, leading to drowsiness. Normally sleepiness occurs as the circadian rhythm causes the release of melatonin and gradual decrease in core body temperature (Fig. 1.1). The circadian cycle depends, on the one hand, on the individual’s chronotype (reflecting at what time of the day their physical functions, i. e., hormone levels, body temperature, cognitive faculties, eating, and sleeping) are active, and on the other hand partly on the person’s sociocultural conditioning and will. The chronotype is commonly reduced to sleeping habits only and determines the ideal timing for a restorative sleep episode. Any individual variation in excess of 2 hours earlier or later than average may cause a person social difficulties. These are classified under “circadian rhythm sleep disorders.” No objective biological differences have been noted between the morning types or evening types outside the high and low hormonal secretion periods. Besides this circadian monophasic rhythm, there appears to be a second rhythm with a 12hour periodicity. This could explain the drowsiness or reduced alertness experienced by many people in the early afternoon.

of light and dark. Other factors, such as ambient temperature, meal times, napping, stress, and exercise, can also influence the timings.

Ultradian Rhythm The ultradian cycle is defined as a rhythmic repetition of certain phenomena in living organisms throughout a 24-hour circadian day. In relation to sleep, the ultradian cycle is defined by the occurrence of (REM) sleep, appearing after a phase of normal non-REM sleep. Usually REM sleep occurs about 90 minutes after sleep onset and is followed by a short waking stage, which allows us to register our dreams. In general, the sleeper forgets most dreams, except for the ones experienced during the last cycle of sleep. REM sleep occupies 15–20 minutes of the last part of each cycle, and is the primer of this ultradian rhythm. In the 1980s, Horne (1988) established that sleep comprises two obligatory parts: deep sleep (Stages 3 and 4, or N3) and REM sleep, the other sleep stages being optional. The duration of the various stages changes during the night. SWS (Stages 3 and 4, or N3) is the dominant sleep stage during the early night, representing about 23% of sleep. During late-night sleep, REM becomes the most active sleep stage, representing about 24% of sleep.

Amount of Sleep It is not how much we sleep, but how well we sleep that matters. Indeed, it has been claimed that Leonardo da Vinci only slept for 20 minutes every 4 hours!

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However, the optimal amount of sleep is only meaningful if it is taken at the right point in the person’s circadian rhythm. If a person’s major sleep episode occurs at the wrong time of the day, it will be relatively inefficient and inadequate. According to Dijk and Lockley (2002), the best time to be asleep is at least 6 hours before the lowest body temperature period. Wyatt et al. (1999) propose that the ideal time to sleep is when the two circadian markers—maximum melatonin concentration and minimum core body temperature— occur after the middle of the sleep episode and before awakening. The need for sleep varies with age and physical condition. A newborn baby sleeps up to 18 hours per day, half of which is in REM sleep. This proportion progressively declines, so that by the age of 5 the child sleeps about 12 hours, with only about 2 hours of REM (Table 1.2).

Consequences of Inadequate Sleep The National Sleep Foundation in the United States defines as optimal 7–9 hours of sleep for an adult, maintaining that sufficient sleep benefits alertness, memory, problem-solving, and overall health, and reduces the risk of accidents (National Sleep Foundation 2002). A study performed at the University of Pennsylvania School of Medicine demonstrated that cognitive performance declines with 6 or fewer hours of sleep (Van Dongen et al. 2003).

Table 1.2 Sleep time and age Age and condition

Average amount of sleep per day (h)

Newborn

Up to 18

1–12 months

14–18

1–3 years

12–15

3–5 years

11–13

5–12 years

9–11

Adolescents

9–10

Adults, including the elderly

7–8

Pregnant women

8

A study of more than one million adults conducted by the University of San Diego found that people who live the longest sleep for 6–7 hours each night (Rowland 2002). Another study shows that sleeping more than 7–8 hours per day has been consistently associated with increased mortality (Patel et al. 2006), although the study suggests that other factors are involved, such as depression and socioeconomic status. It also suggests that the correlation between shorter sleep and reduced morbidity only occurs with those who wake naturally rather than use an alarm clock. British researchers have found that lack of sleep can more than double the risk of death from cardiovascular disease, but that too much sleep may also double the risk of death (Ferrie et al. 2007). This research also indicates that short sleep is a risk factor for weight gain, hypertension, and type 2 diabetes, sometimes leading to mortality. In contrast, no potential mechanisms by which long sleep could be associated with increased mortality have yet been determined. Studies in Germany have explored the increased incidence of cardiovascular accidents in patients with sleep difficulties, especially those with obstructive sleep apnea (Fietze et al. 2010, Oldenburg 2010). Some cardiologists advise cardiac patients to have their sleep evaluated in a sleep laboratory in an attempt to identify and reduce inadequate sleep. The quality of sleep and its relation to chronic pain has been explored in a study by Horlemann (2009). Further, sleep difficulties are closely associated with psychiatric disorders such as depression, alcoholism, and bipolar disorder: up to 90% of patients with depression have been found to have sleep difficulties (Marano 2003). Insomnia has long been thought of as a symptom of depression, but new research shows it may actually trigger the mental disorder (Perlis et al. 2006).

Dreams We dream for about 2 hours each night, which represents a total of about 6 years of dreaming time during a normal life span. Dreams are probably the most fascinating yet the least understood part of sleep. Mostly occurring during REM sleep they appear to be related to

Normal Sleep

the pons, the part of the brainstem relaying sensory information between the cerebellum and cerebrum, which also controls arousal and regulates breathing (Hobson and McCarley1977). However, some believe that several parts of the brain are involved in the dreaming process (Solms 2000). During REM sleep, the release of certain neurotransmitters is completely suppressed. As a result, motor neurons are not stimulated, a condition known as REM atonia. This prevents dreams from resulting in dangerous movements of the body. Most dreams last from 5–20 minutes; REM sleep episodes lengthen progressively throughout the night, with the first episode being shortest and the following episodes increasing to 15–20 minutes at the end of the night. We remember dreams when we wake before the end of the REM period. The ability to recall dreams appears to be related to the vividness of the dream imagery, colors, and emotions. Studies have shown that various species of mammals and birds also experience REM during sleep, and follow the same series of sleeping states as humans (Payne and Nadel 2004).

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Dream Theories ●

There are many current scientific theories that attempt to explain the mechanism and the functions of dreaming. Some of the neurohumoral theories referenced below seem to explain only one or another aspect of dreams. Other hypotheses have been proposed about the function of dreaming; the most interesting ones are from the psychoanalytic schools. Sigmund Freud in his 1900 seminal paper The Interpretation of Dreams (Freud 1994) considers dreams to be symbolic expressions of frustrated desires that have been relegated to the unconscious mind. Dream interpretation plays an important part in Freudian and Jungian psychoanalysis. However, since the 1940s, dream studies in social sciences dropped out of the scientific literature in favor of more self-consciously objective methods: ● Activation synthesis theory. According to Hobson and McCarley (1977), the sensory images and sounds we “see” and “hear” during sleep are the result of the random firing of neurons in the cerebral cortex during REM sleep. These are then reorganized by the forebrain into a

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coherent story in which the person is most often a participant rather than an observer. Hobson and McCarley clearly dismissed the idea that there are deep, nonphysiological, or hidden meanings in dreams. Solms (2000), however, challenges this theory by suggesting that dreams are generated in the forebrain, and that REM sleep and dreaming are not directly related, but are a function of many complex brain structures. This validates Freudian dream theory. Continual-activation theory. Jie Zhang (2004, 2005) proposes that the function of sleep is to process, encode, and transfer data from the temporary memory to the long-term memory. Dreams as excitations of long-term memory. Tarnow (2003) suggests that dreams are ever-present excitations of long-term memory, occurring even during waking life. Linking and consolidation of semantic memories. During REM sleep, the flow of information between the hippocampus and neocortex is reduced due to the increase in cortisol levels (Stikcgold et al. 2001). One stage of memory consolidation involves the linking of distant but related memories, which are then consolidated into a smooth narrative (Payne and Nadel 2004). Eliminating unnecessary memories and connections from the day. This theory was revised by Crick and Mitchison’s (1983) “reverse learning” theory. Testing and selecting mental schemata. Coutts (2008) calls this “emotional selection.” Adler (in Stein 2006) suggested that dreams are often emotional preparations for solving problems. Darwinian random thought mutations, termed “oneiric Darwinism” by Blechner (2001). This theory suggests that dreams create new ideas by generating random thought mutations. Some may be rejected by the mind as useless, while others may be seen as valuable and retained. The result of DMT (dimethyltryptamine) in the brain. This theory was proposed by Callaway in 1988, and suggests a connection between DMT and visual dream phenomena (Wallach 2009). Psychosomatic theory. Dreams are a product of “dissociated imagination,” drawing material from sensory memory for simulation. By simulating the sensory signals to drive the autonomous nerves, dreams can affect mind–body interaction. In the brain and spine, the autono-

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●

mous “repair nerves,” which can expand the blood vessels, connect with pain and compression nerves. These nerves are grouped into many chains, called channels in Chinese medicine (Tsai 1995). Other hypotheses: – Antrobus proposes a mental interpretation of external stimuli, integrating them as part of a dream (Cartwright 1993). – Dreams allow the repressed parts of the mind to be satisfied through fantasy (Vedfelt 2002). – Freud suggested that bad dreams let the brain learn to gain control over emotions resulting from distressing experiences (Cartwright 1993). – Jung suggested that dreams might compensate for one-sided attitudes held in waking consciousness (Jung 1934, 1974, 2002). – Ferenczi (1927) proposes that dreams express that which is not being said outright. – According to Kramer (1993), dreams regulate moods. – Hartmann (1995) proposes that dreams function like psychotherapy, allowing the dreamer to integrate thoughts that may be dissociated during waking life. – In their fulfillment theory of dreaming, Griffin and Tyrell (2003, 2007) suggest that dreaming metaphorically completes patterns of emotional expectation in the autonomic nervous system and lowers stress levels in mammals. Sensory cortex

Right inferior parietal cortex Visual cortex

Positron emission tomography (PET) studies have shown two areas of the brain to be highly activated during REM sleep: the limbic and the paralimbic system. The limbic system is a set of brain structures that include hippocampus, amygdala, anterior thalamic nuclei, septum, limbic cortex, and fornix. It supports a variety of functions including emotional behavior. The paralimbic system consists of the following structures: the pyriform, the entorhinal and parahippocampal cortex on the medial surface of the temporal lobe, and the cingulated cortex. These structures are involved in emotion processing, goal seeking, and motivation. The right hypothalamus, which integrates the sensory– perceptual, emotional, and cognitive functions of the mind with the biology of the body, is also active during REM sleep. Meanwhile, there is a loss of functional connection between the frontal cortex and the posterior perceptual areas, resulting in a lack of reality testing, hence different types of brain communications. In other words, dream images are experienced, biologically and emotionally as reality. In his book Dream Language (2005), R.J. Hoss updates the earlier activation synthesis model of the dreaming brain by Hobson (Fig. 1.2). Table 1.3 presents a compilation of various sources of recent research on the state of the brain in dreaming sleep.

Motor cortex

Cingulate cortex Limbic system Thalamus

Cerebellum basal ganglia

Brainstem

Amygdala

Parts of the brain active during dreaming

Fig. 1.2 Brain activity during dreaming: limbic and paralimbic systems (Hobson and McCarley in Hoss, Dream Language, 2005); see Table 1.3 for details.

Sleep Disorders

Table 1.3 Brain activity during dreaming (Hobson 2002, Hoss 2005, Pannier 2006) Brain structure

Functions

Effect during dreaming

Motor cortex (inactive)

Motor functions

Muscular atonia: body paralysis

Dorsolateral, prefrontal, parietal cortex (inactive)

Rational thought, planning, choice, decision, working memory, will, control of inappropriate behavior

Irrational action, loss of will and control, strange imagery accepted as normal, believing one is awake, forgetfulness upon awaking

Sensory cortex (inactive)

Sensory input

None or very little sensory input

Precunius, lateral and inferior prefrontal cortex (inactive)

Processing of visual memory, recall

Situations producing a dream are different from waking situations

Posterior cingulate (inactive)

Working and episodic memory

Sudden scene changes seem normal, no reflective awareness

Left frontal and temporal areas (inactive)

Language association, speech, naming of things

Dream language becomes metaphoric

Left inferior parietal cortex (inactive)

Distinction between self and others

Perception of self as the other

Pontine stem and thalamus

Initiation of REM sleep, motor pattern generator, arousal and attention

Consciousness, eye movement, movement in dreams, believing one is awake

Right hypothalamus and basal forebrain

Autonomic and instinctual functions, flight or fight, reward

Themes of fear, escape, emotion, reward and motivation

Limbic and paralimbic: amygdala, hippocampus

Emotion and image association, memory processing, emotion processing, goal-directed behavior, social processing

Emotional memories stimulate the dream, themes with emotional features, goal orientation; focus on anomalies of self-image and others

Basal ganglia

Initiation of programmed motor activity

Perception of movement in the dream

Cerebellum

Fine-tuning of movement, motion perception (vestibular sensations)

Sense of movement and body sense

Visual cortex (temporo-occipital)

Integration of visual perceptions, image recognition (face, color, shape…)

Visual dream construction from personal associations and emotions

Right inferior parietal cortex

Spatial and self-perception, orientation, movement, spatial imagery, metaphoric language, pictographs

Dream space as referenced to self, symbolic imagery, metaphoric language

Anterior cingulate

Emotional awareness, error detection, decision-making, appropriate action

Coherent dream scenarios in relation to the dreamer’s concerns, suggestion of future action

Sleep Disorders Sleep disorders are broadly classified as follows.

Dyssomnia Dyssomnias are a broad classification of sleeping disorders, including primary disorders of initiating or maintaining sleep, or of excessive sleepiness. They are characterized by a disturbance in the amount, quality, or timing of sleep. There are over

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30 kinds of dyssomnia, which are subdivided into intrinsic, extrinsic, and disturbances of the circadian rhythm. They include: ● Primary insomnia: a chronic difficulty falling asleep and/or maintaining sleep with no apparent causative factor (see “Insomnia” below) ● Narcolepsy: excessive daytime sleepiness, often culminating in the person falling asleep spontaneously but unwillingly at inappropriate times ● Sleep apnea: a sleep disorder that is characterized by pauses in breathing during sleep ● Obstructive sleep apnea: obstruction of the airway during sleep, causing a lack of sufficient deep sleep, and often accompanied by snoring. Central sleep apnea is less common. ● Hypopnea syndrome: abnormally shallow breathing or a slow respiratory rate while sleeping ● Restless legs syndrome: which manifests as an irresistible urge to move the legs. Restless legs syndrome sufferers often also have periodic limb movement disorder. ● Periodic limb movement disorder, also known as nocturnal myoclonus: sudden involuntary movements of the arms and/or legs during sleep ● Chronobiological disorders, mainly circadian rhythm sleep disorders: the inability to awaken and fall asleep at socially acceptable times, although the person has no difficulty maintaining sleep ● Situational circadian rhythm sleep disorders: shiftwork sleep disorder and jet lag ● Sleep paralysis: characterized by temporary paralysis of the body shortly before or after sleep. It may be accompanied by visual, auditory, or tactile hallucinations. Sleep paralysis is often regarded as part of narcolepsy and is not considered a disorder unless it is severe. ● Parasomnia: events that disrupt sleep, such as sleep-walking, sleep-talking, night terrors, bruxism, bed-wetting, or sleep sex (see “Parasomnia” below)

Parasomnia Parasomnia refers to a category of sleep disorders that involve abnormal and unnatural movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, while sleeping, between sleep stages, or during arousal from sleep. Most parasomnias constitute partial arousal during the

transition between wakefulness and non-REM sleep, or between wakefulness and REM sleep. Parasomnias include the following: ● REM sleep behavior disorder. The normal paralysis occurring during REM sleep is absent or incomplete, allowing the person to act out dreams that are vivid, intense, or violent. ● Night terror, or pavor nocturnus. This involves an abrupt awakening from sleep with behavior consistent with terror. ● Sleep-walking, or somnambulism. Person engages, without conscious knowledge, in activities that are normally associated with wakefulness, such as walking, eating, or dressing. ● Sleep sex, or sexsomnia. Non-REM arousal parasomnia (sexual behavior in sleep) is considered to be a distinct variant of sleep-walking and causes the person to engage in sexual acts. ● Sleep-talking, or somniloquy. Person talks aloud in their sleep. Sleep-talking can range from simple sounds to long speeches. ● Bruxism. This is the involuntary grinding or clenching of the teeth while sleeping. ● Nocturia. This comprises a frequent need to get up and go to the bathroom to urinate at night. Nocturia differs from enuresis, or bed-wetting, in which the person does not awaken, but the bladder empties anyway. ● Exploding head syndrome. Sufferers awaken during the night hearing loud noises.

Secondary to Medical or Psychiatric Conditions This category includes: ● Psychoses, such as schizophrenia and bipolar disorders ● Mood disorders, such as depression or anxiety ● Panic attacks ● Alcoholism Examples of other conditions that disturb sleep are physical pains (lumbar or neck), environmental noises, incontinence, or endocrine causes such as those observed during hormonal changes in the premenstruum or menopausal transitions. The most common sleep disorders include primary insomnia, sleep apneas, narcolepsy, periodic limb movement disorder, restless legs syndrome, and the circadian rhythm sleep disorders. The sec-

Insomnia

ond edition of the International Classification of Sleep Disorders (ICSD) (American Academy of Sleep

Medicine 2005) documents 81 official sleep disorders.

International Classification of Sleep Disorders (American Academy of Sleep Medicine 2005) Adjustment sleep disorder

Insufficient sleep syndrome

Sleep bruxism

Advanced sleep-phase syndrome

Intrinsic sleep disorder

Sleep choking syndrome

Alcohol-dependent sleep disorder

Irregular sleep–wake pattern

Sleep enuresis

Alcoholism

Limit-setting sleep disorder

Sleep hyperhidrosis

Anxiety disorders

Long sleeper

Sleeping sickness

Benign neonatal sleep myoclonus

Menstruation-associated sleep disorder

Sleep-onset association disorder

Mood disorders

Central alveolar hypoventilation syndrome

Sleep paralysis

Central sleep apnea syndrome

Narcolepsy

Sleep-related abnormal swallowing syndrome

Cerebral degenerative disorders

Nightmares

Sleep-related asthma

Chronic obstructive pulmonary disease

Nocturnal cardiac ischemia

Sleep-related epilepsy

Circadian rhythm sleep disorder

Nocturnal eating (drinking) syndrome

Sleep-related gastroesophageal reflux

Confusional arousals

Nocturnal leg cramps

Sleep-related headaches

Congenital central hypoventilation syndrome

Nocturnal paroxysmal dystonia

Sleep-related laryngospasm

Non-24-hour sleep–wake syndrome

Sleep-related painful erections

Delayed sleep-phase syndrome

Obstructive sleep apnea syndrome

Sleep starts

Dementia Parkinsonism

Other parasomnia

Sleep-state misperception

Electrical status epilepticus of sleep

Panic disorder

Sleep-talking

Environmental sleep disorder

Peptic ulcer disease

Sleep/night terrors

Extrinsic sleep disorder

Periodic limb movement disorder

Sleep-walking

Fatal familial insomnia

Posttraumatic hypersomnia

Stimulant-dependent sleep disorder

Food allergy insomnia

Primary snoring

Sudden infant death syndrome

Fragmentary myoclonus

Psychophysiologic insomnia

Hypnotic-dependent sleep disorder

Recurrent hypersomnia

Sudden unexplained nocturnal death syndrome

Idiopathic hypersomnia

REM sleep behavior disorder

Terrifying hypnagogic hallucinations

Idiopathic insomnia

REM sleep-related sinus arrest

Impaired sleep-related penile erections

Restless legs syndrome

Time zone change (jet lag) syndrome

Inadequate sleep hygiene Infant sleep apnea

Rhythmic movement disorder

Toxin-induced sleep disorder

Shift-work sleep disorder Short sleeper

Insomnia Insomnia is the most common of the sleep complaints, affecting 30%–40% of the general adult population and about 15%–25% of children. Primary insomnia is not caused by any physical, psychiatric, or environmental condition. Secondary

insomnia is caused by other intrinsic or extrinsic conditions, medications, or substance intake. Insomnia may be acute, short-term (lasting up to a few weeks), or chronic (when a person suffers from insomnia for at least three nights a week for over a month, including periodic insomnia).

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Causes of Insomnia Causes of acute insomnia include: ● Significant life stress (job loss or change, the death of a loved one, divorce, moving house) ● Illness ● Emotional or physical discomfort ● Environmental factors such as noise, light, or extreme temperatures (hot or cold) that interfere with sleep ● Some medications (e. g., those used to treat colds, allergies, depression, high blood pressure, and asthma) ● Interference with the normal sleep schedule (e. g., jet lag or switching from a day to a night shift) Causes of chronic insomnia include: Depression and/or anxiety ● Chronic stress ● Pain or discomfort at night ●

An important factor in insomnia is wrong sleep hygiene, such as irregular sleeping habits, the effect of stimulating food, drink, and drugs, stimulating activities before sleep, and an uncomfortable sleeping environment. Stimulants and depressants include: ● Caffeine, which acts as an antagonist at the adenosine receptors and slows the action of the hormones in the brain that cause somnolence. Caffeine sensitivity varies from person to person, but its stimulating effects may last for up to 12 hours. It may cause a rapid reduction in alertness as it wears off. ● Energy drinks, which function in much the same way as caffeine. Some individuals experience sleep disruption with certain vitamins, such as vitamin C, or even with mint tea. ● Drugs containing amphetamines ● Cocaine ● Alcohol, which initially causes sleepiness and is therefore commonly used to enhance sleep. However, as it has a rebound effect later in the night, it will seriously disrupt sleep. ● Other depressants such as barbiturates, which act in a similar way to alcohol.

Treatment of Insomnia Treatment strategies for sleep disorders fall into four categories: ● Behavioral/psychotherapeutic treatments ● Rehabilitation/management ● Medication ● Other somatic treatments Hypnotic benzodiazepines are widely used as they represent the least toxicity. The use of barbiturates has greatly diminished. Other classes of drug, such as anxiolytics or neuroleptics, are also used to treat insomnia. Unfortunately, many of the medical drug therapies have inconvenient side-effects, such as habituation and the patient becoming dependent on the artificially induced sleep. Several articles have documented the therapeutic difficulties and side-effects of the drugs that are currently being prescribed for insomnia (Goldenberg 1984, Roy-Byrne and Hommer 1988, Copinschi et al. 1990, Gaillard 1990, Mignot 1991, Buclin et al. 1992). It is important to stress that sleep induced by hypnotics is not physiological: ● Barbiturates and antidepressant drugs cause reduced REM sleep. ● Benzodiazepines and opiates reduce Stage 4 (N3) sleep, the increase in total sleep time being due to an increase in Stage 2 (N2) sleep. Moreover, some individuals have experienced what are known as rebound phenomena when they have tried to stop their hypnotic medication. The following symptoms have been reported (Buclin et al. 1992, Copinschi et al. 1990, Genton 1990, Hanin and Marks 1988, Mignot 1991, Taj 2002): ● Nightmares ● Increase in heart rate and apnea with hypnotic drugs ● Amnesia and attention deficit with some benzodiazepines ● Dependence and tolerance with most products ● Toxicity with certain barbiturates

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Sleep in Chinese Medicine

To understand the pathologies of sleep, we must first explore the significance of sleep in the context of Chinese physiology. Historically, the earliest Chinese discussions about sleep related the sleeping process to the movements of wei qi (defensive energy), orchestrated by the extraordinary vessels, the yin and yang qiao mai (motility vessels). During the Tang dynasty (7th–8th century CE), Chinese physiology became primarily humoral, that is, pathologies were seen through the concept of the five humors, or substances. Thus, sleep was associated primarily with shen (spirit) and its relation to xue (blood). It was not until the Song dynasty (10th–13th century CE) that the zang fu (organ) system was adopted as the basis of Chinese medical physiology. The zang fu and their disharmonies today constitute the foundation of modern Traditional Chinese Medicine (TCM). Besides the humoral and organic theories, the movements of energy, which are responsible for sleeping process, involve the channel system, in particular the extraordinary vessels. It is thus obvious that, in order to be able to understand sleep phenomena, we must consider sleep in the context of yin and yang, qi, xue, and shen theories, the zang fu organ models, and the jing luo channel systems. In TCM, the notion of normal sleep is reflected in the terminology used, that is, an mien = peaceful sleep: an 安 quiet, peaceful, calm (as in calming the shen) mien 眠 sleep (made up of the character for the eye and the character for community) An mien signifies quiet communion with the self, probably through dreams (inner vision). Sleep, being a regularly recurring condition of rest for the body and the mind, could be redefined as somatic stillness (zang fu and jin-sinews) and mental quietness (shen).

Yin/Yang According to basic Chinese premises, daytime and activity are considered to be yang, whereas nighttime and sleep are considered to be yin. Yang grows during the morning, reaching its apex at noon, and declines in the afternoon. Yin grows in the afternoon, reaches its maximum at midnight, and declines in the early morning (Fig. 2.1). In humans, the rhythmic balance between sleep and activity depends primarily on the “internal structure,” the microcosm, and secondarily on external influences, the macrocosm. In a state of health, there is a harmonious balance between

Maximum of yang

Yang Growth Growth

Phase 1

Decline

Phase 2

Decline

Yin Phase 3

Phase 4

Maximum of yin

Maximum of yang Birth of yin Phase 1

Phase 2

Yang Growth of yin Decline of yang

Growth of yang Decline of yin Phase 4

Yin

Phase 3

Maximum of yin Birth of yang

Fig. 2.1 The four phases of yang and yin; growth and decline of yang and of yin.

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yang qi, which expands during the day, and yin qi, which abounds at night. Sleep time, which represents the major part of an infant’s 24-hour cycle, progressively diminishes to about 6–7 hours in an adult. Internal factors balance the length and depth of sleep with the length and intensity of daytime activity. This balance can be viewed as being dependent on two parameters: time and space (Fig. 2.2). In relation to sleep, space may be defined as the depth or intensity of sleep. Internal “synchronizers,” primarily the extraordinary vessels, control these parameters, which in turn define our basic and inherent rhythms. Four of these vessels are not only intimately connected to the internal systems (zang fu), but are also permanently tuned into external variations, such as day and night and the climate (Fig. 2.3). In the absence of a lack of harmony between these syn-

Wake = activity

Yang

Sleep = rest

Yin

Fig. 2.2 Balance between sleeping and waking. Under normal conditions, the length (time) and the depth (space) of sleep are adapted to the length and intensity of daytime activity.

Yang intensity “space” Yang wei mai

Yang “time” Yang qiao mai

Sleep and the Substances: Wei Qi–Xue–Shen Movements of Wei Qi: Physical Relaxation

Normal sleep

Yang

chronizers and other zang fu pathology, the body adapts perfectly to external variations and demands, while keeping its individual characteristics. This capacity to adapt to change defines the individual’s state of health. Insomnia is a yang condition, which in the great majority of cases is due to a disturbance of yin. This yin disturbance is either due to the inability of yin to achieve a proper depth of sleep, which is the case in superficial or dream-disturbed sleep, or due to a shortened sleep time, as witnessed in problems of falling asleep, and early or frequent waking. The type of insomnia is, therefore, defined by whether it concerns the length or the depth of sleep, or both.

Yin “time” Yin qiao mai

Yin Yin depth “space” Yin wei mai

Fig. 2.3 Balance between time and space. The internal organizers of yin and yang, the wei mai and the qiao mai extraordinary vessels.

The Chinese classical text Ling Shu (Spiritual Pivot) describes the circulation of wei qi during the day and the night: “Wei qi circulates on the surface of the body, predominantly along the sinew channels, 25 times during the day, penetrates the deeper layers of the body at the area of the ankle in the evening, circulates in the zang fu through 25 cycles during the night, following the ke (control) cycle of the five movements, and emerges at the corner of the eye, most probably at jing ming, BL-1, enabling the eyes to open” (Ling Shu, French translation 1995) (Fig. 2.4). The text cited here obviously relates to the cycle of sleeping and waking and to the movements of wei qi, and is strongly reminiscent of the role of the yin qiao mai and its synchronization with the yang qiao mai in managing the nycthemeral sleep cycle. The French school, in particular, Nguyen Van Nghi, proposes that the point at which the wei qi leaves the surface to penetrate the deeper parts of the body is zhao hai, KI-6. Wei qi, which is mostly concentrated in the jing jin (sinew channels) during the day, maintains muscle tone and mobility; the process of wei qi moving from the surface to circulate internally allows the muscles to relax. This process is considered the first stage of sleep.

Sleep and the Substances: Wei Qi Blood–Shen

Fig. 2.4 The internal circulation of wei qi during sleep: kidney → heart → lung → liver → spleen → kidney, and so on.

Wei qi is also responsible for surface body temperature. It is interesting to note that modern research has shown that body temperature also presents a 25-hour cycle, and there appears to be some interaction between sleep and body temperature rhythms (Takahashi, 2010). Falling asleep and deep sleep occur during the lowest body temperature dip, whereas waking occurs during the ascending phase of the curve. Master Jeffrey C. Yuen (lecture 2009, personal communication) defines wei qi and this process more precisely. According to Master Yuen, wei qi, being part of yang qi, is rooted in the yuan qi (source qi) and needs to return to the source, the kidneys. If the wei qi cannot fully complete its return to the source—the kidneys—the patient will experience fear in the form of nightmares, and in the case of infants, even convulsions, called jing feng, or fright wind. Master Yuen further says that wei qi also penetrates deeper during the sleep state to protect us against gui (ghost) influences. This kind of gui commonly manifests as gui zha (ghost oppression). Bai Zheng Fu (Ode of One Hundred Patterns) gives indications for: ● PC-5 jian shi for gui xie (ghost evil) ● SP-1 yin bai for gui zha ● ST-45 li dui and SP-1 yin bai for sleeping or dreaming with a heavy sensation on the chest ● LU-3 tian fu for gui yan (ghost talk)

The passage of wei qi to the interior is a consequence of the relaxation of the external jin, the muscles and the tendons. This movement of wei qi mobilizes blood toward the interior, helping it to return to the liver. This would explain the action of points such as qu quan LR-8, yang ling quan GB-34, and yang jiao GB-35 to relax the sinews and help to guide blood to the interior, as indicated for sleep pathologies involving restlessness, for example restless legs syndrome (RLS). Wei qi circulates in the interior during sleep, while ying (nourishing) qi circulates on the exterior. Closing the eyes, which is controlled by jing ming BL-1, corresponds to the deactivation of wei qi. Hence, the extra point yin tang is indicated for insomnia, since it helps to relax the eyes and the nose, and also supports breathing. Jing ming BL-1 is connected to the stomach and large intestine channels (ying xiang LI-20 → cheng qi ST-1 → jing ming BL-1), and also to the small intestine channel (via quan liao SI-18, which continues to ting gong SI-19). Relaxing the eyes helps to relax the nose, as manifested in the deeper breathing occurring when falling asleep, and a blockage in the nose can affect sleeping. Jing ming BL-1 is helpful in sleep apnea and also helps to close the ears. A blockage of qi at the ear can cause a high-pitched ringing in the ears or cause the person to hear their own heartbeat. Jing ming BL-1, as a confluent point of yang qiao mai, can be regulated by shen mai BL-62. Supplementing BL-62 helps the patient to wake up; reducing it helps the patient to sleep. The closing of the eyes is the first manifestation of the wei qi moving inward. The second area the wei qi has to pass through is the chest. The chest needs to relax and to loosen up in order to permit the wei qi to further descend to the zang fu. In the absence of this relaxation, a person may wake up during the night feeling hot and sweating. This shows the importance of relaxing the xiong (chest) and ge (diaphragm), which affects the zong qi (chest [gathering] qi), with points such as ge shu BL-17 and zong hui TB-7: ● BL-17 is used for night sweating, tidal fevers, steaming bone syndrome, and menopausal syndrome (as it cools the blood). ● Hui zong TB-7 helps move wei qi downward toward the abdomen (and is used when the patient wakes in the night to eat).

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●

● ● ●

Jian shi PC-5 can also be used for sleeping disorders associated with eating late, causing stomach yin xu vacuity, with empty heat disturbing sleep. It can also be used for eating disorders (food compensation). Yin bai SP-1 is used for excessive dreaming, restlessness, and fright wind (nightmares). Yin bai SP-1 + li dui ST-45 is supplemented for excessive sleeping, reduced for insomnia. From the chest, wei qi moves to the abdomen and down to ming men GV-4 with the liver as the zhu (chief governor or emissary), given its position between the heart shen and kidney jing.

In the Daoist tradition, sleep is a preparation for death, and restless sleep forebodes a restless death:

Wei qi Ying qi Yuan qi

Jing jin (sinew channels) = process of relaxation Luo mai (connecting channels) = PC luo / KI luo SP great luo / GV luo / CV luo Jing bie (divergent channels)

Fig. 2.5 The inward movement of wei qi and the collateral channels.

solutions or resolutions. In the absence of any emotional issues to process, wei qi moves back to the primary channels. Sleep is then restful and one wakes up rested and rejuvenated.

Shen: Mental Relaxation “We die in the same manner that we sleep.” Master Yuen further elaborates on the movement of wei qi inward: under the control of the lung, the liver releases the ying outward, causing the hun (ethereal soul) to move out and wander (rapid eye movement [REM] sleep). The wandering of the hun can be seen as the liver releasing its internal wind, that is, the emotions. Hun includes aspects of memory, the record-keeper, but also insights into the future, as the liver is associated with time (that is, qi men LR-14). Wei qi, being the result of the conversion of ying qi (nourishing qi), should also move back to the ying level. This process involves the secondary or collateral channels, particularly the luo (connecting channels) (Fig. 2.5). As described by Master Yuen, the return of wei qi to the ying level involves the luo mai, in particular the pericardium luo, which moves to the chest, and the kidney luo, which returns to the lower abdomen. Three other luo help bring back the wei qi to the yuan, the spleen great luo and the luo of the ren mai (conception vessel) and du mai (governing vessel). As the luo are heavily involved with the blood and shen, they act as a buffer system and manage our emotional responses to the world. The involvement of the luo during the night gives us the opportunity to review the psycho-emotional impacts of our daily life in the form of dreams manifesting as challenges, prompting us to find

Sleep is defined as a regularly recurring condition of rest for the body and mind. Body rest results from the relaxation of the jin (sinews) and the movements of wei qi. Mental relaxation is in the domain of the shen.

Shen 神 In the Chinese classics, shen has been defined as spirit or spirits, gods, creative instance, organizing spirit or principle, subtle influx received from heaven, mysterious cause (unfathomable metaphysical principle), pure action, transforming force, and creative force that enhances growth, elaborates, and completes the transformation of an individual and his or her consciousness of the world. Shen is a collective term for the emotional, mental, and spiritual aspects of human existence; hence, it is involved in learning, intelligence, memory, the ability to differentiate emotions, and coherence of thoughts, association, and alertness (jing shen). On the one hand, shen is responsible for our perception of reality. In Confucianism, the cultivation of the mind (that is, the thoughts) changes our perception of reality. On the other hand, shen represents our spiritual evolution. Shen is responsible for how our life mandate (ming), stored in the kidneys, will be manifested and carried out. In the Daoist tradition, the heart channel points represent the nine steps or stages in life. Master

Sleep and the Substances: Wei Qi Blood–Shen

Yuen calls these points the nine steps towards redemption, recovery, and sovereignty:

HT-1: ji quan Highest Spring Endless possibilities HT-2: qing ling Green-Blue Spirit

A young soul

HT-3: shao hai Lesser Sea

Ocean of life

HT-4: ling dao Spirit Path

Path for the soul

HT-5: tong li Connecting Li

Life challenges

HT-6: ying xi Yin Cleft

Theme of life (mid-life crisis)

HT-7: shen men Spirit Gate

Entering the heart

HT-8: shao fu Lesser Mansion

Less residence (attachment)

HT-9: shao chong Lesser Surge

Less blueprint (less curriculum, less karma)

Hence shen, being responsible for our spiritual evolution, will manifest through the offices of the hun in the form of dreams, enacting the challenges of our chosen life curriculum (predetermined life mandate). One can process these challenges by practicing lucid or conscious dreaming (see Chapter 5). When difficulties are encountered in this processing, the dream is experienced as a nightmare. On the other hand, shen also represents the sum total of our emotions and is responsible for their manifestation. Therefore, all emotions will affect the shen and disrupt the heart, causing sleep problems: ● Anger will cause heart fire. ● Joy or excitement and sadness affect heart qi. ● Pensiveness affects heart blood. ● Fear and fright (shock) in adults affects heart– kidney communication. Mental activity is the combined interaction of consciousness, qi (energy/function), and the nao (brain). It can, therefore, be summarized as the manifestation of the “Three Treasures”: Shen—spirit

Resides in the heart

Consciousness and wakefulness are defined by the activity of the shen. Awareness is the result of the harmonious activity of the zang fu as expressed by shen ming (clarity of the spirit). Mental activity may be summarized as: ● Shen receiving the sensory input (consciousness, alertness) ● Processing (digestion) of the information by the yi (intellect, thought/mindfulness) ● Storing of the information by the zhi (will) (Fig. 2.6) All information is understood, properly analyzed, and stored accordingly in this manner.

Yi 意 Yi represents the thinking process, concentration in thinking and focusing, providing boundaries, and giving meaning to experiences. Yi functions through memory, analysis, synthesis, thinking, classification, concentration, focusing, symbolism, abstract thinking, conceptualization, ideas, learning, integration of sensory, mental and emotional input, and physical awareness. All sensory information processed by yi will, therefore, be broken down, as in the digestive process, into separate components, to be understood

Sensory input

Shen

Yi Analysis

→ Coordination, coherence

Qi—energy

Produced by the spleen → Function

Jing—essence

Stored in the kidneys

→ Brain matter

Zhi

Storage

Fig. 2.6 Mental activity and the role of shen, yi, and zhi.

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and integrated, and to be stored in appropriate compartments according to color, sound, sensation, emotion, and so on. The recollection of an event, when experienced consciously and hence analyzed by yi, will contain all the associated events, even the memory of the experience, without actually reactivating the emotion experienced at the time. Hun and po (corporeal spirits) ensure the “free flow” and the “entry and exit” of movements. When shen is disconnected, as is the case in sleep, hypnosis, or coma, hun and po take over and store the memories. Yi then no longer analyzes the sensory input. Instead, hun stores the impressions and emotions, and po stores physical sensations (Fig. 2.7). As hun and po do not analyze the experience, the memory is stored in its entirety, and when this is recalled or reactivated, the person will experience the whole event as though it were occurring right there and then. These unexplained and apparently illogical responses are referred to as gui in Chinese medicine.

Gui 鬼 The Chinese notion of gui, an unnamed spirit, entity, or energy mass, refers to apparently unexplained or inappropriate reactions to outer stimuli. This is the case in unconscious conditioning, hyp-

Sensory input

Shen

Hun

Yi

Po

Fig. 2.7 In the absence of shen and yi, hun stores impressions and emotions (behavioral gui), while po stores physical sensations and pain (somatic gui).

nosis, phobias, behavioral neurosis, many psychosomatic diseases, and of course most psychotic manifestations. Both hun and po contain the radical gui in their ideograms.

Hun 魂, Po 魄 Hun is responsible for behavioral gui, and po is the origin of somatic gui. According to the correspondence system, wu xing (five moving forces or phases and five elements), at all times the three planes of man’s constitution—spiritual, emotional, and physical—are always interrelated. Hence the physical (somatic) or emotional levels may affect the higher mental aspects or, vice versa, psycho-emotional states may have an effect on the somatic body. It is necessary here to point out that there are two representations of the five elements, which have most often been confounded: the “cosmogenic order” describes the creation order of the elements and represents the universal structure, that is, our internal structure. In this model, the earth element is represented in the center, identified by the character di 地. This model is usually used to represent the wu xiang (five directions, with the earth as the center), or the wu ji (four seasons, plus the earth in the center, representing the seasonal interphase). In this text, I will refer to this model as five elements, as it represents five invariable positions. As far as I am aware, no Chinese term has been used to differentiate this model. On the other hand, the term wu xing refers to the well-known “correspondence system” of the five moving forces, also called the five phases, and describes the homeostatic interrelationship of the organs and the correspondence with external and internal factors. In this model, the earth is considered one of the changing phases, and is represented by the character tu 土 (Fig. 2.8). Hence, the five moving forces wu xing reflect the substance disharmonies and the consequences of the external climatic, internal emotional, and other dietary and lifestyle causes of disease and their consequences on various organs. The five elements, on the other hand, explain the inner structure of the psyche and the interrelationship between shen (mind), hun (ethereal soul), po (corporeal soul), yi (intellect), and zhi (will) (Fig. 2.9).

Sleep and the Substances: Wei Qi Blood–Shen

Maximum of yang Birth of yin South

Growth of yang East Decline of yin

Fire

Growth of yin West Decline of yang

Wood

North Maximum of yin Birth of yang

Earth

Metal

Water

The cosmogenic order of the universe: 4 + 1 (the four directions and the center)

Fire Wood

Earth Wu xing

Water

Metal

The correspondence system: the five movements 3 + 2 (3 yang + 2 yin)

Fig. 2.8 The five phases and the five moving forces.

During sleep, shen retires to the xue, which explains a person’s reduced response to outer stimuli. Modern analysis of the brain using an electroencephalogram (EEG) shows an important slowing down in the electrical activity of the brain waves that is different from that seen in a state of simple relaxation or quiet wakefulness (see Chapter 1). The sleep stages as evidenced on an EEG can be equated with the five aspects of the psyche (Hervé de Coux 1991) (Table 2.1). In the absence of shen, hun and po are responsible for protecting the individual. This explains the need for the deep penetration of wei qi at night in order to protect against gui. When shen has difficulty in quieting due to emotions or blood vacuity, a person will have difficulty falling asleep due to excessive mental activity, called zao (agitation).

At night, blood moves back inside to be stored in the liver, and the hun soul also returns inward, although it is occasionally liberated to wander, which explains the phenomenon of dreaming (see Chapter 5).

Xue, Shen, and Hun The function of the blood is to nourish and to moisten. The absence of this moistening process results in dryness of the organs and a condition called zang zao (visceral agitation). When zang zao affects the mind, mental conditions such as panic attacks, paranoia, and phobias occur. Blood is also called the “mother of qi,” and is believed to be the medium of our intentions. It is said that blood contains consciousness. According

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●

H E A V E N

M A N

Po

Shen

Mental– spiritual level

Yi Zhi

Hun

Cogitation

Joy, excitement Anger

Sadness

Emotional level

Fear

Finally, how we feel about a person or situation relates to the lung and po, and disconnection, whereas feeling disconnected or rejected relates to the pericardium According to Chinese texts, blood stores both shen and hun, hence the importance of blood in the physiology of sleep. Blood vacuity therefore affects the shen and the hun and may cause sleep disturbances involving difficulty falling asleep. These are classified as: ● Calm insomnia: zao (agitation) involving heart blood, with mental activity (mental agitation) ● Restlessness: fan (vexation), involving liver blood, with muscular restlessness

SP-ST

HT-SI E A R T H

The heart, the seat of shen, which defines our connections or interpersonal encounters

LR-GB

LU-LI

Physical (somatic) level

KI-BL

Fig. 2.9 Man’s three planes of existence: the physical, or somatic level, the emotional level, and the mental–spiritual level.

Table 2.1 Mental states and activity of the psyche by Hervé de Coux (La Peur et le Rêve 1991) Mental state

EEG activity Element

Psychic activity

Consciousness

Beta

Earth

Yi

Alert watchfulness Alpha

Fire

Shen

Relaxed watchfulness, drowsiness

Theta

Metal

Po

Deep sleep

Delta

Water

Zhi

Wood

Hun

Paradoxical sleep, Beta REM sleep

to Master Yuen, the three organs involved in consciousness are: ● The spleen, which houses yi, and represents our boundary and contact with the world ● The liver, which houses the hun, and is responsible for our interaction with the world

In cases of blood vacuity where the blood cannot contain shen and hun, there will in addition be easy and frequent waking, and dream-disturbed sleep. The person will also manifest emotional vulnerability, will be easily startled and overly sensitive, have the urge to fidget, and or have memory loss, usually for the most recent events. Other conditions that disturb the blood also disrupt sleep: ● Blood heat causes agitated sleep with a tendency to depression, irrationality, and impulsiveness. If the heat is internal, there is more likely to be fan with heat in the chest, whereas external heat generates zao, with heat in the limbs resulting in the need to fidget. ● Blood stagnation will also cause agitated sleep through the consumption of blood, and over time leads to lao (taxation). This pattern is most common among those with severe psychological conditions involving worry, anxiety, or depression coupled with eating disorders or addictive behaviors such as those involving alcohol, drugs, or sex. Blood stasis often leads to forgetfulness, dementia, and even to kuang (mania).

Sleep and the Zang Fu

Sleep and the Zang Fu Heart, Sleep, and the Emotions The heart (xin) is the primary zang responsible for regulating sleep on account of its main function being to house the shen. The role of shen in the sleeping process has already been discussed. However, the heart is also responsible for the states of xue, which also have a central role in the initiation and maintenance of sleep. As all emotions affect the heart, causing heat, they can all have an effect on sleep (please see p. 17). Practically all heart pathologies, especially those producing heat, will disrupt the sleeping process, namely: ● Heart fire or phlegm–fire ● Heart blood vacuity (xin xue xu) or heart yin vacuity (xin yin xu) ● Lack of communication between the heart and the kidney (xin shen bu jiao) ● Heart qi vacuity (xin qi xu) or heart yang vacuity (xin yang xu) Other heat patterns involving the pericardium, xin bao (external heat), or triple burner, san jiao (damp–heat), will also affect the heart, with the same consequences for sleep.

Hun, the Liver, and Dreaming Dreams are indispensable to health, although the reason remains unclear. In Western medicine, this phase of sleep is termed rapid eye movement (REM) or paradoxical sleep. Two phenomena occur during dreaming, and both are strong indicators that the liver is involved in the process: rapid eye movement, which may be associated with internal wind; and the flow of blood towards the outer genitalia, the territory of the liver channel, connecting back to the jing level. Rapid eye movement denotes intense visual activity, a kind of inner vision, through which the liver releases its internal wind. The importance of dreaming, the different kinds of dreams, and their interpretations will be further explored in Chapter 5. In pathological disturbances, hun may wander excessively to cause dream-disturbed sleep or nightmares.

The liver plays a primordial role in the sleeping process. During the waking stage, the liver manages the circulation of wei qi on the surface and, through the jing jin, muscular activity. The liver is also responsible for the eyes and vision. The liver plays an important role in the initiation of sleep by mobilizing wei qi inward, which results in a lowering of muscle tone. We have seen that this movement of wei qi to the interior causes sensory relaxation as well, starting with the eyes, the nose, and then the ears. The movement of hun inward helps move qi away from the head and helps relax the shen. Where the process of movement of hun to the interior is disturbed, this will manifest as difficulty falling asleep through zao. According to Master Yuen, the liver acts as the zhu (emissary), given its position between kidney jing, the water phase, and heart shen, the fire phase (noting that the deep pathway of the kidney channel passes through the liver to ascend to the lung and the heart): ● The first stage of sleep is enabled by the liver and lungs, which allow the body to relax (any disturbance in this stage would cause difficulty falling asleep). ● The second stage involves the liver interacting with the spleen to maintain sleep (any disturbance in this stage would cause difficulty staying asleep). ● The third stage, in which the liver interacts with the kidneys, inducing deep sleep, as in concentration without distraction (any disturbance in this stage would cause restless sleep). ● Finally, the liver interacts with the heart or pericardium, inducing rejuvenation and regeneration through liberation or redemption from one’s predetermined course or ming, via the processing that takes place through dreams. This interaction between the liver and pericardium allows for lucid dreaming or vivid awareness during the dream state in order to: ● Bear witness to, or at least to prepare oneself to observe, the events of the past and future (the role of the hun) and to observe our reactions to these events (the role of the pericardium) ● Eventually, achieve the goal of the practice of lucid dreaming, which is to consciously place oneself in a challenging situation and to develop solutions or resolutions

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Master Yuen further compares the sleep stages to processes involved in meditation: N1: Drowsiness, falling asleep

Relaxation (physical and mental)

N2: Superficial sleep, maintaining sleep

Concentration (no external distraction)

N3: Deep sleep

Meditation (complete inner stillness)

REM sleep: Dreaming

Levitation (detachment of spirit)

Sleep and the Fu As it moves inward and passes through que pen (ST-12), the chest, and the diaphragm, wei qi will descend to the fu (bowels). According to Master Yuen, wei qi descends in order to ensure that the process of “rest and digest” takes place, with yang qi moving inward via que pen (ST-12) (except for the bladder channel). Any stagnation in the transport of wei qi in the fu will affect sleep, causing insomnia with visceral symptoms such as bloating, colic, or hunger. Additionally, there will be specific signs and symptoms due to the counterflow of qi via da zhui (GV14) toward bai hui (GV-20): ● Large intestine (LI): teeth-grinding, neck and shoulder tension (and often also difficulty in moving bowels in the morning) ● Stomach (ST): difficulty falling asleep, fan, and nighttime food cravings ● Bladder (BL): difficulty falling asleep with zao (e. g., RLS, calf cramps, and so on) and nighttime sweating ● Small intestine (SI): dry mouth, nighttime thirst, and enuresis ● Gallbladder (GB): bitter taste, itching (mostly of the head), and neck tension ● Triple burner (TB): drooling and a lot of crusting around the eyes

Sleep and the Extraordinary Vessels All yin and yang phenomena correspond to the eight extraordinary channels or vessels (qi jing ba mai). These channels, which act as reservoirs, maintain internal balance and harmony, and adapt the inner milieu, the microcosm, to outer variations, the macrocosm. The extraordinary vessels are considered to be the link between the pre-heaven and the post-heaven qi. The four fundamental channels—chong mai (penetrating or thoroughfare channel), du mai (governing channel), ren mai (conception channel), and dai mai (belt or girdling channel)—are directly connected with the source, dong qi (the moving qi between the kidneys) (Fig. 2.10). The four fundamental channels participate in the first cellular divisions. Chong mai, du mai, and ren mai, often with the addition of dai mai, are referred to as the “first ancestry” and are considered to be the “source of creation.” These four extraordinary vessels all derive qi from the kidneys and circulate the jing qi through the body: ● Ren mai distributes yuan qi / jing qi mainly to yang ming (yang brightness). ● Chong mai distributes to the three yin levels (tai, jue, shao). ● Du mai distributes mainly to tai yang (supreme yang). ● Dai mai distributes mainly to shao yang (lesser yang) and tai yang.

Navel Dong qi

Ming men

Fig. 2.10 Dong qi—the moving qi between the kidneys. Origin of three of the four fundamental vessels.

Sleep and the Extraordinary Vessels

The other four extraordinary vessels, which originate in the kidney and bladder channels, are mainly involved in modulating (regulating) yuan qi: ● Yin and yang wei mai (binding or linking vessels) regulate variations in the yin and yang spaces. ● Yin and yang qiao mai regulate variations in the yin and yang rhythms (times). The kidneys, through the chong mai and ren mai, program and regulate the cycles of life (puberty, menopause, and so on), and through the yin and yang wei mai and yin and yang qiao mai regulate not only rhythmic changes (sleep–wake, menstrual cycle, cycle of pregnancy), but also psycho-spiritual transformations. The eight extraordinary vessels distribute jing qi to the six extraordinary fu organs, and integrate them into the zang fu system (Table 2.2). They act to consolidate and regulate the “quantity” of qi in the main channels by: ● Absorbing any excess yang (external heat, or liver yang rising) or any excess yin (damp, phlegm) ● Transferring qi to a deficient channel ● Redistributing qi between different areas in the body: – Front/back: ren mai and du mai (also chong mai) – Exterior/interior: yin and yang wei mai – Upper/lower body: dai mai – Right/left: yin and yang qiao mai – Day/night: yin and yang qiao mai – Regulating the circulation of wei qi: yin and yang qiao mai

The role of the eight extraordinary vessels in the regulation of sleep cycles and the impact their disturbance may have on sleep patterns is clear. It also seems quite probable that there is a direct connection between these vessels and central nervous system activity, as evidenced by some of the symptoms, and especially the pathways, of the extraordinary vessels: all except dai mai reach the head; du mai, yin and yang qiao mai penetrate the brain directly, and chong mai and ren mai penetrate the brain via ST-1 and BL-1. At all times yang activity must be balanced by yin rest.

Organization of Yang Four of the extraordinary vessels are responsible for all yang activities, spaces, and phenomena (Fig. 2.11): ● Du mai, the Sea of Yang, recapitulates all yang activities. ● Yang wei mai, the Preserver or Binder of Yang, maintains the balance between inside and outside, and controls wei qi on the surface. ● Yang qiao mai accelerates yang. ● Dai mai maintains the distribution of yang and regulates the upper and the lower parts of the body.

Organization of Yin In a similar manner, four of the extraordinary vessels are responsible for all yin activities, spaces, and phenomena (Fig. 2.12):

Table 2.2 The six extraordinary fu organs and the eight extraordinary vessels Extraordinary fu organs

Extraordinary mai vessels

Western anatomical or physiological equivalent

Nao (brain)

Du mai/yin qiao and yang qiao mai

Nervous system

Sui (marrow)

Chong mai/du mai

Hematopoietic system

Gu (bones)

Chong mai/du mai/ren mai

Electrolytic system

Mai (vessels)

Chong mai

Vascular system

Dan (gallbladder)

Dai mai

Hepatic portal system

Nu zi bao (uterus)

Chong mai/ren mai

Genital system

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Dai mai Yang organizer

Yang

Yang wei mai Yang preserver (Yang space)

Du mai Sea of yang ●

Yang qiao mai Yang accelerator (Yang time)

Fig. 2.11 The regulation of yang by the four yang extraordinary vessels.

Yin qiao mai Yin accelerator (Yin time) Yin wei mai Yin preserver (Yin space)

Yin

Ren mai Sea of Yin

Chong mai Yin organizer

Fig. 2.12 The regulation of yin by the four yin extraordinary vessels.

● ●

●

●

Ren mai, the Sea of Yin, nourishes yin and recapitulates all yin activities. Chong mai, Sea of Blood, Sea of the five Zang and the six Fu, Sea of the 12 Channels, is the organizer of yin. Yin wei mai, the Preserver or Binder of Yin, maintains the balance between the inside and outside and controls the blood; hence, it influences the heart and the shen. Yang qiao mai regulates the intensity of yin, mainly at nighttime, and accelerates yin.

Organization of Sleep The yin and yang qiao mai have traditionally been indicated for sleep pathologies, more specifically for symptoms related to day and night: ● Yin qiao mai symptoms: – Repletion: hypersomnia, headaches, epilepsy (worse during the day); medial leg pains or general spasms, lumbar pain (radiating to the genitals or to the chest and

neck); difficulty swallowing; redness of the inner corner of the eye, chronic eye diseases – Vacuity: insomnia, headaches, pains (worse at night); convulsions; weakness or paralysis of the legs; blurred vision, difficulty opening the eyes, anuria, spermatorrhea, impotence, sterility, menstrual cycle problems, and so on Yang qiao mai symptoms: – Repletion: insomnia; headaches (worse at night); lumbar pains, one-sided pains or weakness; pains and tightness (not localized, worse at night), lateral leg and hip pains and spasticity; internal or external wind; convulsions, tinnitus, epilepsy, Parkinson disease; nose bleeds; red and painful eyes, exophthalmia – Vacuity: lassitude during the daytime, lack of strength, unilateral paralysis of the leg, hemiplegia, apathy; excessive lacrimation

The yin and yang wei mai are involved in regulating wei qi and in its movements between the surface and the deeper areas; hence, they play an important role in the muscular and mental relaxation necessary for sleep to occur: ● Yang wei mai symptoms: – Repletion: alternating fever and chills; sensitivity to changes in the weather; insomnia with easy waking; chest oppression; changing moods; pains and spasms, lumbar pain; skin hyperesthesia, arthralgia (of the hands or heels), parotiditis, diarrhea, headache with heat or thunderstorms; red eyes or excessive lacrimation (with wind); otitis, deafness, tinnitus; acute sinusitis; facial neuralgia; eczema of the neck or ears – Vacuity: coldness, loss of strength with changes in the weather (snow, rain); weakness or stiffness of the limbs ● Yin wei mai symptoms: – Repletion: tightness or pain in the chest (tai yin [supreme or greater yin]: stinging pain; jue yin [terminal yin]: sharp pain; shao yin [lesser yin]: stabbing pain); pain along the lower border of the rib cage; pain and spasms in the legs, very cold limbs, energy shooting upward in the body, intense headaches (vertex or occiput), hypertension; intestinal gas; lumbar aches (after emotional shock); palpitations; fear, panic attacks, phobia, agitation, nervous tics, nervous eating

Sleep and the Extraordinary Vessels

– Vacuity: vacuity of the heart and lung, hypotension, ptosis; depression, tears; oversensitivity; insomnia resulting from fear A number of recent studies have demonstrated that, under normal conditions, the internal organization of sleep allows for a reduction in the length of sleep due to an increase in its depth with no somatic consequences (Horne and Wilkinson 1985). Yin and yang are constantly maintained in a dynamic state of balance by the regulating function of the yin and yang wei (linking) and the yin and yang qiao vessels (Fig. 2.13). A disturbance of yin, for example yin vacuity, suggests either a weakness of the yin wei vessel or the yin qiao vessel, or an excess of the opposite yang wei or yang qiao vessels. Thus, when assessing sleep disorders, it is also important to consider the complementary yang vessels. It may be presumed that “time” is organized by the yin qiao and the yang qiao vessels, and that “space” is managed by the yin wei and yang wei vessels. Therefore, it can be assumed that sleep, being a yin phenomenon, is synchronized in its temporal structure by the yin qiao vessel and in its depth and intensity by yin wei vessel. These two regulators are naturally in equilibrium with the other two synchronizers, the yang qiao and yang wei vessels, which relate to a state of wakefulness and activity, thus balancing sleep with activity. As a result, the more intense or prolonged the activity, the deeper the sleep. The most pertinent fact about the four extraordinary vessels which appear to regulate “time” and “space” (in other words, our basic rhythms

Yang intensity “space” Yang wei mai Wake = activity

Yang Yang “time” Yang qiao mai

Sleep = rest

and cycles) is that traditionally xi (cleft) points have been indicated for them. Now, the function of a xi point is to de-obstruct or to unblock, indicating that these channels can in fact be obstructed in a similar way to the primary channels. Furthermore, the sensitivity of these xi points, when palpated, is an excellent indicator that these channel systems are disturbed.

Time In its temporal movements, yin is first shao yin, then tai yin, and then jue yin. This sequence can be seen in life as well as in all phenomena: all things begin shao (small), then they grow tai (big), and then grow old, tired, worn down, and become terminal (jue). Sleep, in its temporal structure, is regulated by the yin qiao vessel, as indicated by the classical statement on wei qi that “it penetrates inside at the medial ankle at night, and emerges at jing ming, BL-1 in the morning, allowing the eyes to open” (Ling Shu). Therefore, in a temporal sequence, the initial stage of sleep—that is, falling asleep and the first hours of sleep—corresponds to the shao yin segment. The middle stage of sleep corresponds to the tai yin segment. The last, or third stage of sleep is related to the jue yin segment (Fig. 2.14). The yin qiao mai sequence starts with shao yin points: ran gu KI-2, zhao hai KI-6, and jiao xin KI-8. The channel then runs through the territories of tai yin, abdomen, and jue yin, chest, without specific confluent points (Fig. 2.15). This means that if sleep is disturbed in its temporal structure, the yin qiao or its complementary yang qiao mai will manifest a disturbance, as evidenced in the sensitivity of their respective xi points.

Yin “time” Yin qiao mai

Yin

Yin qiao mai

Normal sleep Yin depth “space” Yin wei mai

Fig. 2.13 In normal sleep, the length (time) and the depth (space) of sleep are adapted to the length and intensity of daytime activity. The qiao and the wei mai maintain this state of dynamic balance.

Shao yin Tai yin

Jue yin

Yin Sequence in “time” = Yin rhythms

Fig. 2.14 Yin qiao mai and the three yin sequences in time: shao yin → tai yin → jue yin.

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Space BL-1 ST-9 ST-12

KI-6

KI-8 KI-6 KI-2

In its intensity, yin is first tai yin, then jue yin, and then shao yin. This spatial organization relates to the order of the primary channels in the body, from the outside to the inside, where the shao yin is the deepest level (Fig. 2.16). The term “depth” is defined as the position of the channel in relation to wei/nei (outer/inner), where yang is exterior, and yin interior (Fig. 2.17). Tai yang is the outermost channel, which is in contact with the world; then comes shao yang, and then the deepest yang, yang ming. Tai yang is more yang than yang ming, and therefore closer to the outside (wei). The yin channels are energetically closer to the inside (nei). This organization in space is clearly demonstrated in the disposition of the 12 primary channels in the body, where the most yang zones will be tai yang, followed by shao yang, then yang ming, then tai yin (the yin closest to the outside), followed by jue yin, and then shao yin, the deepest yin in the body. The yin wei mai point sequence on the trunk clearly demonstrates the three levels of yin as it runs through the three sections (Fig. 2.18):

Fig. 2.15 Yin qiao mai and its constituent points.

The six zones

Fig. 2.16 The “spatial” distribution of yin and yang, from back to front: tai yang, shao yang, yang ming, tai yin, jue yin, and shao yin.

Sleep and the Extraordinary Vessels

● ●

Tai yang ●

Shao yang Yang ming Tai yin Jue yin Shao yin

Fig. 2.17 The “spatial” distribution of yin and yang, from outside to inside: tai yang, shao yang, yang ming, tai yin, jue yin, and shao yin.

Tai yin: fu she SP-13, da heng SP-15, fu ai SP-16 Jue yin: qi men LR-14, coming back to the conception vessel Shao yin: lian quan CV-23, knot of shao yin

This spatial organization of sleep signifies the quality or the depth of sleep. The depth of the initial phase of sleep corresponds to the tai yin segment, and the middle phase of sleep corresponds to the jue yin segment. The quality of the last phase of sleep corresponds to the shao yin segment (Fig. 2.19). If sleep is disturbed in its spatial structure, that is, in its quality, the yin wei mai, the yin linking vessel, or its complementary yang wei mai, will manifest a disturbance, as evidenced in the sensitivity of their respective xi points.

Yin variations in “space” = intensity or quality of sleep

Yin wei mai

CV-22, CV-23

LR-14

PC-6

SP-16 SP-15 SP-13

Tai yin: SP-13, SP-15, SP-16 Jue yin: LR-14 Shao yin: KI-9, CV-23

KI-9

Fig. 2.18 Yin wei mai and its constituent points.

Tai yin

Jue yin

Shao yin

Fig. 2.19 Yin wei mai and the three yin sequences in space —initial phase: tai yin → mid-phase: jue yin → end phase: shao yin.

In summary, and as an aid to the Western reader, the author has provided a comparison of the physiology of sleep according to Western medicine and classical Chinese medicine (Table 2.3).

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Table 2.3 Comparison of Western and Eastern physiology of sleep Western medicine

Chinese classical medicine

Sleep

Rest for body and mind

Body stillness and mental quietness

Physiology

Lowered body temperature

Wei qi (responsible for surface heat and protection) moving inward

Reduced immunity Circadian synchronizers

Suprachiasmatic nuclei—pineal gland (melatonin)

The eight extraordinary vessels Yin tang and bai hui GV-20

Mental states:

EEG activity:

Shen activity of the pysche:

●

Consciousness

●

Beta

●

Yi ↔ Earth element

●

Alert watchfulness

●

Alpha

●

Shen ↔ Fire element

●

Relaxed watchfulness

●

Theta

●

Po ↔ Metal element

●

Deep sleep

●

Delta

●

Zhi ↔ Water element

●

REM sleep

●

Beta

●

Hun ↔ Wood element

Dreaming

Purpose of sleep

Purpose of dreaming

REM sleep: rapid eye movements

Wandering of the hun

Loss of muscle tone

Wei qi and blood leaving the sinews

Erection and female lubrication

Blood returning to the liver (liver luo channel)

Restoration, anabolism

Building up yin, ying qi

Immune functions, healing

Wei qi returning to the kidney

Memory

Hun (retrieval of memory)

Memory consolidation

Hun and zhi

Psychosomatic theory

Shen leading the qi

Premonitory dreams

Hun and memory of the future

Releasing of repressed emotions

Hun releasing retained heat (external pathogens or internal emotions)

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Insomnia

In Chapter 2, sleep was defined as a regularly recurring condition of rest for the body and the mind. Based on this definition, insomnia is difficulty in achieving either physical or mental relaxation, or both. Insomnia is the most common of the sleep disorders, affecting more than one third of the general adult population and about one quarter of children. Thus, what is important is not how long we sleep but how well we sleep. Therefore, an alternative definition of insomnia would be insufficient or unsatisfactory sleep. In both cases, insufficient yin is generated to respond to the day’s physical and mental activities. When analyzing sleep, the main factor is not, therefore, the length of sleep but the person’s state upon waking. Has sleep been restful for the body and revitalizing for the mind? If the patient complains of tiredness upon waking, this is considered in Chinese medicine to be insomnia, even if the person has slept for 12 hours. Insomnia is a yang condition, which in the great majority of cases is due to a disturbance of yin. This yin disturbance is either due to the inability of yin to achieve proper depth—which is the case in superficial or dream-disturbed sleep—or to a shortened sleep time—as witnessed in problems falling asleep and early or frequent waking. The type of insomnia, therefore, is defined in accordance with whether it affects the length or the depth of sleep, or both. Reduced sleep time may be the consequence of: ● Dfficulty falling asleep ● Frequent waking for various reasons ● Early waking (Fig. 3.1) Unsatisfactory sleep may be due to: ● Superficial sleep due to mental restlessness or physical agitation with visceral manifestations such as restless legs syndrome (RLS) and pruritis ● Dream-disturbed sleep, nightmares, sleepwalking, sleep-talking, and so on ● Other pathologies that disturb the quality of sleep, such as snoring, sleep apnea, respiratory difficulties, or pain (secondary insomnia)

Wake

A

A>B Reduced time = “quantity”

Sleep

B

Missing time

Fig. 3.1 Insomnia through reduced sleeping time = quantity.

Wake AA A

Sleep

B A>B Reduced depth = “quality”

B

Missing depth

Fig. 3.2 Insomnia through reduced depth of sleep = quality.

In all these cases, sleep is not revitalizing enough, and it can be said that the yin is not reaching the appropriate depth during the night (Fig. 3.2). In most chronic cases of insomnia, both variables, that is the length and the quality of sleep, are affected, making the treatment that much more complex. It must be emphasized that, in Chinese medicine, insomnia is not a disease but a symptom. Any pattern of disharmony that produces yang repletion or yin vacuity can result in disturbed sleep. All those emotions that affect the shen may equally disrupt sleep or dreams. The complexity in diagnosing the causes of insomnia lies in the fact that the following all need to be considered so that finally the involved zang fu (organ) pattern can be identified: ● The state of the substances, that is, xue (blood) and the yin, and possibly the jin ye (fluids) ● The overall state of the mind and the emotions ● The movements of wei qi (defensive qi)

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I propose a simpler and more systematic way of approaching the problem. As we have seen in the previous chapter, all disharmonies of yin or yang will ultimately influence the eight extraordinary vessels. These vessels attempt to harmonize and in some ways keep the body in equilibrium. When the capacities of the extraordinary vessels are exhausted, the symptom—in this case insomnia— will manifest itself. Thus, if we analyze the state of the extraordinary vessels, namely the four vessels dealing with variation in time and space, we can establish which of the primary channels are dysfunctional, and hence which zang fu are involved.

Diagnosing Insomnia As defined above, insomnia is the inability to reach sufficient physical or mental relaxation, or both. In Traditional Chinese Medicine (TCM), it involves the state of wei qi, of xue, and of the shen. Also, the period of wakefulness is of great importance as it indicates which channels are disturbed. The main task of the TCM practitioner is to define whether sleep is disturbed in its temporal sequence (duration of sleep), its spatial quality (depth of sleep), or both. As each parameter is subdivided into three phases, we can divide the night into roughly three phases of 1.5–3 hours each, which correspond respectively to an initial, middle, and end phase of the night, or sleep. If a person’s normal sleep is roughly 6–7 hours, for example, each phase will be equal to about 2–2.5 hours. The first step is thus to establish in which phase of the night sleep is disturbed: ● Initial stage insomnia (initial phase of the night/sleep) = difficulty falling asleep ● Middle stage insomnia (middle phase of the night/sleep) = waking up in the middle of the night ● End-of-the-night/terminal stage insomnia (end/ terminal phase of the night/sleep) = waking early ● Insomnia may also affect the entire sleep time due to frequent waking. The second step is to establish the person’s physical state when awake:

●

●

Physical tension or restlessness, which usually indicates liver blood vacuity, whereas mental agitation denotes an unsettled shen, signifying heart blood vacuity Somatic symptoms, such as teeth grinding (bruxism), restless legs, bloating, hunger, itching and so on are due to an inability of the wei qi to move in or to remain inside.

The third step is to explore the patient’s mental and emotional state during the wake phase: ● Is the mind calm and quiet? ● Is there coherent and clear mental activity, during which the person is wide awake, thinking about projects, resolving problems or analyzing options, putting the light on to read, or even going to watch television, and so on? ● Conversely, is the mind confused, irritated, and tired? Is the person unable to concentrate and too tired to read? Are thoughts fragmented with no coherence? ● What emotions are present when the patient is awake: worry, fear, anxiety, sadness? Finally, what is the person’s state upon waking? Are they obviously tired due to the insomnia? Do they find it difficult to get out of bed? Are they in a bad mood and irritable, or are they depressed? When the length of time (quantity) of sleep is affected, the person is wide awake at night and the mind is either totally calm or may be active but clear; it is as though the sleep cycles have been completed. The person may engage in mental activity for an hour or more until sleep returns. If the insomnia occurs at the end of the night, the person usually gets out of bed and goes about their daily activities. If the quality of sleep is disturbed, the person is tired but cannot find sleep, the mind is unclear, or there is physical or mental restlessness. As we have seen in Chapter 2, in its temporal movements, yin is first shao yin (lesser yin), then tai yin (supreme or greater yin), and finally jue yin (terminal yin). Sleep, in its temporal structure, is regulated by the yin qiao mai (yin motility or yin springing vessel), and its complementary yang qiao mai (yang motility or yang springing vessel). If there is difficulty falling asleep with a clear or calm mind, as is the case when the patient reads for a while before falling asleep, the yin qiao is disturbed in its initial segment. This first segment is represented by the shao yin, which corresponds to

Diagnosing Insomnia

a heart and/or kidney disharmony pattern, for example heart yin vacuity, heart blood vacuity, or kidney yin vacuity. If the patient wakes in the middle of the night with a clear or calm mind, the cause of the insomnia is to be found in the second segment of yin qiao, the tai yin. Hence, the lung or spleen channels and organs are involved, for example, lung or spleen qi vacuity, lung heat, or stomach heat. Finally, if the person wakes too early and is wide awake, it is the last segment of yin qiao, the jue yin channel that is involved, indicating pathologies of the liver or pericardium, as are commonly seen in liver blood vacuity or liver yin vacuity, pericardium qi vacuity, pericardium fire, or liver fire. On the other hand, if the quality of sleep is affected, either sleep is very superficial or the person feels tired but cannot sleep. The mind is not clear but is tired, confused, even chaotic and irritated. Alternatively, sleep will be disturbed by somatic manifestations, such as restless legs, neck tension, grinding of the teeth, abdominal bloating, unrestrained eating at night, sweating, pruritis, or respiratory difficulties such as snoring or sleep apnea. The quality of sleep may also be affected due to excessive dreaming or disturbing dreams, such as nightmares, or by sleep-walking, or sleeptalking. In any event, sleep is not restful for the body or for the mind. The quality or depth of yin is regulated by the yin wei (yin binding) vessel and its complementary yang wei (yang binding) vessel. The three phases of the night also correspond spatially to the three channels, which constitute the three segments of yin or yang: ● The first phase of the night corresponds to tai yin. The person will present with restlessness and maybe snoring or other visceral manifestations. The disharmony responsible for these symptoms can be found in the tai yin (lung and spleen) systems, such as spleen qi vacuity, lung heat, stomach heat, and so on. ● The middle phase of the night corresponds to the jue yin (liver and pericardium) channels. Pathologies such as liver blood vacuity or liver yin vacuity, pericardium qi vacuity, pericardium fire, or liver fire will cause restlessness, nightmares, muscle cramps, or other disturbances that reduce sleep efficiency. ● The last phase of the night corresponds, in its

spatial disposition, to shao yin, heart and kidney, channels. Sleep will be disturbed by symptoms such as hot flashes, sweating, disturbing dreams, or various emotions, as well as pain, most typically lumbar pain. The nature of the sleep disturbance can be assessed quite quickly based on this diagnostic approach. Once it has been established that sleep is disturbed in its temporal or spatial structure, that is, in its length or quality, the diagnosis can be confirmed by palpating the xi (cleft) points of the four extraordinary vessels: ● Jiao xin KI-8 on the yin qiao vessel ● Fu yang BL-59 on the yang qiao vessel ● Zhu bin KI-9 on the yin wei vessel ● Yang jiao GB-35 on the yang wei vessel After establishing that the extraordinary vessels are involved, the segment of the night during which the sleep is disturbed will indicate which vessels are involved and hence their associated zang fu: ● Difficulty falling asleep and the person has a clear mind (reads for an hour before falling asleep). In this case, the yin qiao vessel is involved, which is confirmed by the tenderness of jiao xin KI-8. The channels to be considered are the shao yin (heart and kidney) channels. The treatment will involve five or six points: zhao hai KI-6 on the side where jiao xin KI-8 is sensitive, lie que LU-7 on the opposite side, and shen men HT-7, tai xi KI-3, lian quan CV-23, or some other appropriate shao yin point such as you men KI-21, shen feng KI-23, ling xu KI-24, shen cang KI-25, and so on. ● Difficulty falling asleep, the person is too tired to read, or they cannot fall asleep from worry. Zhu bin KI-9 is sensitive, which confirms a yin wei vessel disturbance and therefore involves the tai yin (lung and spleen) channels. Nei guan PC-6 should be treated with gong sun SP-4 on the opposite side, possibly zhu bin KI-9, da heng SP15 as a tai yin point of yin wei mai, and appropriate tai yin points: yin bai SP-1 (together with li dui ST-45 for worry) and san yin jiao SP-6. ● Waking between 1 a.m. and 3 a.m. with a clear mind indicates that the yin qiao vessel is probably disturbed and jiao xin KI-8 is sensitive to palpation. The tai yin (lung and spleen) channels are involved. The treatment combines zhao

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3 Insomnia

●

●

●

hai KI-6 with lie que LU-7 and other tai yin points according to symptoms: zhong fu LU-1, zhong wan CV-12, and san yin jiao SP-6. Waking between 1 a.m. and 3 a.m., or restless sleep with nightmares, asthma attacks, or other visceral manifestations, is an indication of suspected yin wei vessel involvement, which is confirmed by palpating zhu bin KI-9. The jue yin channels (liver and pericardium) are disturbed. The treatment consists of nei guan PC-6 with gong sun SP-4 on the opposite side, qi men LR-14 as a jue yin point of yin wei mai and other jue yin points such as da ling PC-7, jian shi PC-5, tai chong LR-3, or qu quan LR-8. Early waking. The person is wide awake, and jiao xin KI-8 is tender. The involved jue yin (liver and pericardium) channels should be treated, together with regulating the yin and yang qiao mai: zhao hai KI-6 or shen mai BL-62 with da ling PC-7, jian shi PC-5, tai chong LR-3, or qu quan LR-8. Early waking: because of night sweating or nightmares, the person is tired but cannot find sleep. Zhu bin KI-9 is tender. The yin wei and the shao yin channels (kidney and heart) should be treated, for example nei guan PC-6 with gong sun SP-4 and fu liu KI-7, and yin xi HT-6 with shen men HT-7 and another of the shao yin points suggested above.

Where there is no underlying zang fu pathology and the sleep disorder is caused by a recent disturbance of the synchronizing extraordinary vessel alone, as witnessed in jet lag or in shiftworkers, we usually find that only one of the four extraordinary vessels will show a disturbance, most often the yin qiao vessel. In such cases, the treatment is simple and the response is quite fast, that is, jiao xin KI-8 is supplemented on the dominant side (left for men, right for women), or according to xi-cleft sensitivity; shen mai BL-62 is reduced on the opposite side and yin tang is used. Another possibility is to harmonize the yin and yang wei channels, especially if sleep is of poor quality, by reducing wei guan TB-5 and reinforcing nei guan PC-6. For example, a standard combination of points for jet lag is wei guan TB-5 with he gu LI-4 (which helps improve the quality of sleep). When an underlying pathology is causing the insomnia, more than one of the organizing extraordinary vessels may be affected. For example:

●

●

●

Blood vacuity first affects the heart, which may disturb the yin qiao vessel, affecting the initial phase of sleep (shao yin). If the yin wei vessel is involved, this will affect the third phase of sleep. If both vessels are affected, the patient will have difficulty falling asleep (initial stage insomnia), and will have superficial or dreamdisturbed sleep during the third phase. If blood vacuity also affects the liver, the patient will have difficulty falling asleep and will wake early when the yin qiao vessel is disturbed. In cases where the yin wei vessel is also affected, bad quality of sleep with restlessness is present in the second and third stages of sleep. When the problem is chronic, both yin wei and yin qiao vessels are involved and the whole sleep cycle will be disturbed. Here the treatment has to include supplementing the deficient substance—blood or qi—as well as synchronizing the appropriate extraordinary vessels (Figs. 3.3–3.5).

Etiology and Treatment of Insomnia Movements of Wei Qi Wei qi has to move into and circulate in the interior during sleep. This inward movement of wei qi, which is a consequence of the relaxation of the external muscles and tendons, helps to mobilize blood to the interior so that it can return to the liver. The first stage of this movement is represented by closing of the eyes, and is controlled by jing ming BL-1. The relaxation of the eyes helps to relax the nose and supports breathing. Symptoms Difficulty in the movement of wei qi at the eyes can cause: ● A blockage in the nose, with snoring or obstructive sleep apnea (OSA) ● A blockage at the ear, with high-pitched ringing or the ability to hear one’s own heartbeat Treatment Jing ming BL-1, which may be replaced by yin tang, together with the regulation of yang qiao mai, by

Etiology and Treatment of Insomnia

Shao yin - HT fire (PC heat) - HT blood vacuity = HT-SP blood vacuity = HT-LR blood vacuity - HT yin vacuity = HT-KI yin vacuity - HT qi vacuity = HT-GB qi vacuity - HT yang vacuity = HT-KI yang vacuity

Tai yin

Yin Qiao Mai (if KI-8 is sensitive)

Shao yin Tai yin

Fig. 3.3 Shao yin heart–kidney pathologies will disturb either the initial phase of sleep, with difficulty falling asleep, or the terminal phase, with poor-quality sleep.

Jue yin

Shao yin pathologies will shorten sleep, with difficulty falling asleep with a clear mind

Jue yin Shao yin

Yin Wei Mai

Shao yin pathologies will disrupt the sleep quality at the end of the night

(if KI-9 is reactive)

Yin qiao mai (if KI-8 is sensitive)

Jue yin - LR fire - LR blood vacuity (HT-LR blood vacuity) - LR yin vacuity - GB qi vacuity (HT-GB qi vacuity)

Shao yin Tai yin

Jue yin

Jue yin pathologies will shorten sleep, with early waking with a clear mind

Tai yin Jue yin Shao yin

Yin wei mai

Jue yin pathologies will disrupt sleep quality in the middle of the night

(if KI-9 is reactive)

Fig. 3.4 Jue yin pericardium– liver pathologies will disturb either the terminal phase of sleep, with early waking, or the middle phase, with poor-quality sleep.

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3 Insomnia

Yin qiao mai (if KI-8 is sensitive)

Tai yin - LU heat - LU qi vacuity - SP qi vacuity - ST heat - ST heat-phlegm

Shao yin Tai yin

Fig. 3.5 Tai yin lung–spleen pathologies will disturb either the middle phase of sleep, through waking up with a clear mind, or the initial phase, with poor-quality sleep.

Jue yin

Tai yin pathologies will shorten sleep, with waking in the middle of the night with a clear mind

Tai yin

Jue yin Shao yin

Yin wei mai

Tai yin pathologies will disrupt sleep quality in the first part of the night

(if KI-9 is reactive)

reducing shen mai BL-62, and of yin qiao mai, by supplementing zhao hai KI-6. Add ying xiang LI-20 or bi tong for nasal blockage and ting gong SI-19 for ear manifestations. In the second stage, the wei qi has to pass through the throat area. Symptoms A blockage at this level causes: ● Snoring and OSA ● A choking sensation Treatment Relax the throat. Tian ding LI-17, fu tu LI-18, or lian chuan CV-23, que pen ST-12 (inward passage of qi), with yun men LU-2 (controls the movements of wei qi) and zhong fu LU-1 (helps with the inward movement of qi and blood, and opens the chest). In the third stage, the chest needs to relax to permit the wei qi to descend further to the zang fu. Symptoms In the absence of this relaxation, the person: ● Wakes up at night with a feeling of heat and sweating

●

Experiences chest oppression, with the sensation of something sitting on the chest: gui zha (ghost oppression)

Treatment Ge shu BL-17 (night sweating, tidal fevers, steaming bone syndrome, menopausal syndrome), zong hui TB-7 (helps move wei qi downward toward the abdomen: when the person wakes up to eat); jian shi PC-5 (for gui xie [ghost evil]), yin bai SP-1 (for gui zha); additionally, shan zhong CV-17 and gao huang shu BL-43. In addition to the above points, nei guan PC-6 is indicated to help open the chest, to regulate yin wei mai, and to improve the quality of sleep. In the fourth stage, wei qi moves to the abdomen and down to ming men and the kidneys. If the wei qi cannot fully complete its return to the source (the kidneys), the person will experience “fright wind,” which manifests as nightmares in adults or, in the case of children, both nightmares and infantile convulsions. The stagnation of transport in the fu (bowels) will affect sleep. Here, the insomnia is due to the fact that the wei qi is released outward by a coun-

Etiology and Treatment of Insomnia

terflow movement of qi via da zhui GV-14 toward bai hui GV-20. Symptoms Additionally, there are specific signs and symptoms that indicate which fu is involved: ● Large intestine: with grinding of the teeth, and neck and shoulder tension (also often difficult bowels in the morning) ● Stomach: difficulty falling asleep, fan (irritability), nighttime food cravings ● Bladder: difficulty falling asleep, with zao (restlessness) (e. g., restless legs syndroms [RLS], calf cramps, etc.) with nighttime sweating ● Small intestine: dry mouth, nighttime thirst, enuresis ● Gallbladder: bitter taste, itching (mostly of the head), neck tension ● Triple burner: drooling, a lot of crusting around the eyes Treatment To help bring the wei qi back down, bai hui GV-20 or si shen cong (EX-HN-1) and que pen ST-12 should be combined with the lower he (sea) point and jing (well) point of the corresponding channel: ● For the large intestine channel: shang ju xu ST37 and shang yang LI-1 ● For the small intestine channel: xia ju xu ST-39 with shao ze SI-1 ● For the stomach channel: zu san li ST-36 and li dui ST-45 ● For the bladder channel: wei zhong BL-40 and zhi yin BL-67 ● For the gallbladder channel: yang ling quan GB-34 with zu qiao yin GB-44 ● For the triple burner channel: wei yang BL-39 and guan chong TB-1

Movements of Blood The inward movement of wei qi, which is a consequence of relaxation of the external muscles and tendons, helps mobilize xue to the interior so that it can return to the liver. If this inward movement of wei qi and of xue is disturbed, it can result in an accumulation of wei qi and blood in the muscles. This causes initialstage insomnia with zao, which manifests as mus-

cle tension, cramping, or the typical RLS. Points such as qu quan LR-8, yang ling quan GB-34, and yang jiao GB-35, xi–cleft of yang wei mai are indicated to relax the sinews and help with the inward movement of blood. Xue can also move out during sleep, causing the hun (ethereal soul) to become unsettled and to wander. This manifests as excessive dreaming, nightmares, or even sleep-walking. The propensity of blood to move out is related to: ● The condition of xue: blood heat, blood vacuity, or more rarely blood stasis ● The state of the liver: liver qi stasis, especially liver heat or liver fire The treatment has three objectives: ● To harmonize xue by supplementing (pi shu BL20, gan shu BL-18, xin shu BL-15, san yin jiao SP-6), moving (ge shu BL-17, gao huang shu BL-43, tai chong LR-3), or cooling (wei zhong BL-40, xue hai SP-10) ● To harmonize the liver by moving liver qi (tai chong LR-3), supplementing liver yin (que quan LR-8, gan shu BL-18), or extinguishing liver fire (xing jian LR-2, lao gong PC-8) ● To calm the shen and settle the hun. There are three strategies for dealing with shen, depending on the state of blood (see the section “To Calm the Shen” p. 41).

Zang Fu Pathologies Fire Phase Heart Fire Symptoms ● Difficulty falling asleep due to anxiety ● Nightmares, dreams of flying ● Mental and emotional restlessness ● Bright eyes, loud voice, reckless character ● Always feeling hot, thirsty ● Tachycardia, hypertension, heart diseases ● Tongue ulceration, bitter taste ● Tongue: red, red tip, yellow coating ● Pulse: rapid, overflowing Treatment Shen men HT-7, shao fu HT-8, jue yin shu BL-14, xin shu BL-15, ju que CV-14, shen feng KI-23, hou ding GV-19, jiu wei CV-15, and jian shi PC-5.

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Phlegm Fire Harassing the Mind Symptoms ● Difficulty falling asleep due to anxiety ● Nightmares ● Snoring, chest oppression ● Nausea, lack of appetite ● Tongue: red, red tip, yellow coating ● Pulse: rapid and slippery Treatment Jian shi PC-5, lao gong PC-8, shao fu HT-8, jue yin shu BL-14, zhong wan CV-12, shui fen CV-9, feng long ST-40. Heart Blood Vacuity Symptoms ● Difficulty falling asleep ● Anxiety, restless sleep, frequent waking ● Dreams, nightmares, dreams of flying ● Palpitations ● Dizziness, blurred vision, poor memory, problems concentrating, feeling spaced out ● Tongue: pale ● Pulse: choppy or weak Treatment Shen men HT-7, jue yin shu BL-14, xin shu BL-15, ju que CV-14, shen feng KI-23, ling xu KI-24, hou ding GV-19, jiu wei CV-15 and jian shi PC-5, san yin jiao SP-6, pi shu BL-20, ge shu BL-17, zu san li ST-36, yin tang EX-HN-3. Heart Blood Stasis Symptoms Anxiety when lying down, restless sleep ● Dream-disturbed sleep ● Palpitations ● Chest pains, angina ● Tongue: purple, or spots ● Pulse: choppy ●

Treatment Nei guan PC-6, shen men HT-7, tong li HT-5, shen feng KI-23, jue yin shu BL-14, xin shu BL-15, ge shu BL-17, xin shu BL-15, gao huang shu BL-43.

Heart Yin Vacuity (Often Associated with Kidney Yin Vacuity: Heart and Kidney Out of Harmony) Symptoms ● Difficulty falling asleep, restless sleep, frequent waking ● Dry throat, palpitations, night sweats, “five palm” heat ● Tinnitus, lumbar pains ● Tongue: peeled, red tip, cracks, heart crack ● Pulse: floating and empty Treatment Shen men HT-7, jue yin shu BL-14, xin shu BL-15, ju que CV-14, shen feng KI-23, hou ding GV-19, jiu wei CV-15, jian shi PC-5, san yin jiao SP-6, guan yuan CV-4. For heart and kidney yin vacuity, add: yong quan KI-1, tai xi KI-3, zhao hai KI-6, xin shu BL-15, shen shu BL-23, shen tang BL-44, zhi shi BL-52. Heart Qi Vacuity (Often Associated with Gallbladder Qi Vacuity) Symptoms Superficial sleep, insomnia from anxiety ● Easily startled, timid, indecisive ● Palpitations (arrhythmia) ● Shortness of breath, fatigue, depression ● Tongue: pale, swollen at the front, possibly heart crack ● Pulse: empty ●

Treatment Shen men HT-7, jue yin shu BL-14, xin shu BL-15, ju que CV-14, ling xu KI-24, shen cang KI-25, nei guan PC-6, qiu xu GB-40, shan zhong CV-17, qi hai CV-6, zu san li ST-36. Heart Yang Vacuity Symptoms As above; often accompanies kidney yang deficiency ● Dislikes cold, gets cold with emotions ● Tongue: pale, bluish ● Pulse: slow, deep ●

Treatment As above, but add ming men GV-4, da zhui GV-14, bai hui GV-20.

Etiology and Treatment of Insomnia

Pericardium Qi Repletion Symptoms ● Same as heart fire in relation to external heat (fevers) ● Congestion, heart pain ● Overexcitement, sexual perversions Treatment Treatment as above, but add jian shi PC-5, nei guan PC-6, da ling PC-7. Pericardium Qi Vacuity Symptoms ● Same as heart blood vacuity or heart qi vacuity ● Needs a lot of rest, easily tired ● Sexually stimulated but not satisfied Treatment Jue yin shu BL-14, gao huang shu BL-43, shan zhong CV-17. Damp Heat in Triple Burner Symptoms Extreme nervous tension, overexcitement ● Repressed emotions; willful, cannot stand people ● Gallbladder symptoms: tics, spasms, trembling, convulsions ● Sensitive to changes in the weather ● Sudden deafness ● Hypertension with nervousness ●

Treatment Guan chong TB-1, tian jing TB-10, wei guan TB-5, ge shu BL-17, shi men CV-5, yin jiao CV-7, zhong wan CV-12, shan zhong CV-17.

Wood Phase Liver Fire Symptoms ● Restless sleep, nightmares, waking early ● Anger, irritability, envy, jealousy ● Headaches ● Liver symptoms, internal wind ● Bitter taste in the mouth, red face, dark urine, dry stools ● Tongue: red sides, dry yellow coating ● Pulse: rapid and wiry

Treatment Xing jian LR-2, tai chong LR-3, zu qiao yin GB-44, wan gu GB-12, or an mien (EX-HN-54), feng chi GB-20, gan shu BL-18, hun men BL-47, bai hui GV-20, ben shen GB-13, or tou lin qi GB-15, shen ting GV-24; also treat the kidney. Liver Blood Vacuity Symptoms ● Fan, waking early, vivid dreams ● Internal wind symptoms, eye symptoms ● Tongue: pale sides ● Pulse: choppy Treatment Gan shu BL-18, pi shu BL-20, ge shu BL-17, shen shu BL-23, qu quan LR-8, san yin jiao SP-6; or an mien (EX-HN-54). Liver Yin Vacuity Symptoms ● Restless sleep, waking early, sleep-walking or sleep-talking ● Nightmares, excessive dreaming, irritability ● Dryness of the throat, eyes, skin, and hair ● Feeling of heat ● Dizziness ● Tongue: dry, peeled sides, maybe red ● Pulse: floating and empty, or thin and rapid Treatment Gan shu BL-18, hun men BL-47, qu quan LR-8, san yin jiao SP-6, ting hui GB-2, ben shen GB-13, shen ting GV-24; also treat kidney yin. Gallbladder Qi Vacuity (Often Associated with Heart Qi Vacuity) Symptoms Insomnia from insecurity, light sleep, excessive dreaming ● Waking early, difficulty getting up ● Easily startled, timid, lack of will and initiative ● Palpitations, shortness of breath, fatigue ● Tongue: pale, swollen ● Pulse: empty ●

Treatment Add qiu xu GB-40 and wan gu GB-12 or an mien (EX-HN-54).

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Earth Phase

Metal Phase

Spleen Qi Vacuity

Lung Heat

Symptoms ● Waking at 3 a.m., sleep-walking ● General fatigue with daytime sleepiness ● Bloating after meals, soft stools ● Tongue: pale, swollen with tooth marks ● Pulse: empty

Symptoms ● Insomnia with agitation, waking at 3 a.m. ● Asthma, cough, yellow sputum ● Tongue: red at the front ● Pulse: flooding and fast

Treatment Pi shu BL-20, zhang men LR-13, shang qu KI-17, da du SP-2, tai bai SP-3; also yin bai SP-1 and nei ting ST-44.

Treatment Fei shu BL-13, zhong fu LU-1, chi ze LU-5, kong zui LU-6, yu ji LU-10, bu lang KI-22, he gu LI-4, qu chi LI-11, feng long ST-40, jian shi PC-5. Lung Qi Vacuity

Stomach Heat Symptoms ● Restless sleep; frequent dreams, nightmares ● Needing to eat or drink in order to fall asleep ● Mental fan, discontent, accusing ● Agitation (if extreme, the compulsion to climb to high places to sing, or to undress and run around madly, for example) ● Moving and talking too fast ● Gastritis, thirst, halitosis (bad breath), hunger ● Acne, red eyes ● Tongue: stomach crack, red, yellow dry coating ● Pulse: flooding Treatment Wei shu BL-21, yin jiao CV-7, zhong wan CV-12, lie que LU-7, jie xi ST-41, zu san li ST-36, liang men ST21, yin bai SP-1, nei ting ST-44.

Symptoms ● Waking at 3 a.m. ● Weak breathing, cough, asthma, frequent colds ● Dry skin, loss of hair ● Tongue: swollen at the front, pale ● Pulse: empty, floating Treatment Fei shu BL-13, zhong fu LU-1, tai yuan LU-9, bu lang KI-22, he gu LI-4.

Water Phase Kidney Yin Vacuity, Accompanied by Heart Yin Vacuity (Also Referred to as Heart and Kidney Not in Harmony) Symptoms Difficulty falling asleep, restless sleep, frequent waking ● Lumbar pain ● Tinnitus ● Palpitations, night sweats, “five heart” heat ● Dry throat; dark urine ● Tongue: peeled, cracks, red ● Pulse: floating and empty or thin ●

Damp–Heat Harassing the Mind Symptoms ● As above, plus snoring ● Heaviness, obesity, chest oppression ● Tongue: swollen with tooth marks, sticky coating ● Pulse: slippery and fast Treatment Same as stomach heat, also add tou wei ST-8, jian shi PC-5, feng long ST-40, li dui ST-45, yin ling quan SP-9, shui fen CV-9.

Treatment As for heart yin vacuity. Add yong quan KI-1 if the shen is very unsettled, you men KI-21 if the patient is tired but cannot sleep, shen feng KI-23 for a restless mind, shen cang KI-25 for insomnia from worry, yu zhong KI-26 for waking in a bad mood, and shu fu KI-27 for persistent insomnia.

Etiology and Treatment of Insomnia

Kidney Yang Vacuity, Accompanied by Heart Yang Vacuity Symptoms ● Superficial sleep, insomnia from anxiety ● Easily startled, timidity, indecisiveness, cold with emotions ● Dislike of cold ● Lumbar pain, frequent urination ● Palpitations (arrhythmia) ● Shortness of breath, fatigue, depression ● Tongue: pale, bluish ● Pulse: slow, deep Treatment Shen men HT-7, tai xi KI-3, xin shu BL-15, shen shu BL-23, zhi shi BL-52, ju que CV-14, ling xu KI-24, shen cang KI-25, ming men GV-4, da zhui GV-14, bai hui GV-20.

In Chinese physiology, physical health is dependent on the free flow of qi and xue, which is in turn dependent on freedom of the mind. On the other hand, the free flow of the mind depends on the free circulation of qi and xue. Thus, physical and psychological healths are interdependent. The mind, which is orchestrated by shen, perceives the world and responds accordingly through the offices of the five zang. The specific movement of qi in each zang is the expression of its zhi (will). When this strength is expressed harmoniously, there is no emotion. But if there is an excessive use of this will, the organ will produce its corresponding emotion. Therefore, the fact that an emotion is being expressed, as well as its intensity, will indicate how the mind perceives the world. This explains the central importance that is given to the cultivation of the mind in Daoism, Confucianism, and Buddhism. The cultivation of thoughts changes the perception of reality.

Emotions In Chinese medicine, emotions are considered to be the body’s driving force. The classical concept of the “Five Emotions and Seven Passions” refers to the emotions in their normal and pathological aspects. The body’s basic program is to perpetuate life, the will to live. This desire for life is represented in the symbolism of the heart as the emperor, where shen resides. The natural order of life is tranquility of the heart; hence, any behavior that does not follow this rule is considered abnormal or pathological. The five basic emotions are necessary for survival and for inner freedom, choice, and inner peace. The five emotions are the natural reactions of the shen to environmental changes, in relation to the wu xing, the five moving forces. Emotions are called the seven passions when they are not rooted in the basic desire for life. The number seven here symbolizes the destructive forces, and refers to when an emotion is excessive, repressed, or unadapted to the situation. An empty heart perceives all and makes choices, whereas a heart occupied by desires distracts the consciousness and causes inappropriate responses. –Master Yuen

Confucian saying

The Five Movements and the Five Wills ●

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● ● ●

Hun is the will of the liver, giving it the ability to move forward; when in excess, it produces anger. Shen is the will of the heart, giving it the ability to expand; when in excess, it produces excitement. The will of the spleen is the ability to transform; when in excess, it produces worry. The will of the lung is to gather and separate; when in excess, it produces sadness and grief. The will of the kidney is to consolidate; when in excess, it produces fear.

Although a person’s overall mental and emotional equilibrium is referred to as their shen, shen itself is the sum of the five shen (spirits), also called the five zhi (Fig. 3.6). Excessive or inappropriate emotions will disrupt the corresponding organ, either by producing heat, through suppression, or by depleting the qi, xue, or yin of the organ. Ultimately, all emotions affect the shen and the heart, producing heart heat or heart fire:

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Shen

Shen Yi Hun Po Zhi

Fig. 3.6 Shen, in a sense, is composed of the manifestation of the five spirits.

● ● ● ●

Anger will cause heart fire. Joy/excitement and sadness affect heart qi. Pensiveness affects heart blood. Fear and fright (shock) in adults affects heart– kidney communication.

As the xin (heart) is the primary zang responsible for regulating sleep, all emotions affecting the heart can disrupt sleep. One of the functions of hun during sleep, especially during the dreaming, or rapid eye movement (REM), phase, is to help release this emotional accumulation. This aspect of dreaming is explored in more detail in Chapter 5.

Management of Emotional Patterns That Disturb Sleep Please note that the treatment of psychiatric conditions, which very often also produce serious sleep disturbances, is beyond the scope of this book. Less severe emotional disturbances in a normal human being resulting from reactions to environmental changes respond readily to acupuncture. The emotion may be easily identified by the patient, who cannot fall asleep or who wakes up with that particular emotion, such as worry, sadness, grief, anger, fear. Alternatively, the dream pattern is suggestive of an emotion, as explored in Chapter 5. The treatment strategy has two aims: ● To release the emotion ● To calm the shen

Releasing the Emotion Using the Five Zhi Points on the Outer Bladder Line ● Shen tang BL-44: for clarity and intelligence; calms the shen. Combine with shen shu BL-23 and zhi shi BL-52 for depression and insomnia. ● Hun men BL-47: for lack of direction and aim in life; depression, irritability, anger, frustration, anxiety, a vague feeling of fear at night. Combine with shen shu BL-23 and zhi shi BL-52 for difficulty relating to others. ● Yi she BL-49: strengthens memory, improves concentration, releases obsessions and worry. Combine with shen shu BL-23 and zhi shi BL-52 for thinking in circles. ● Po hu BL-42: enhances introspection, supports the instinct of self-preservation and being comfortable with oneself. Treats sadness, grief, loss, and worry about the future. With shen shu BL-23 and zhi shi BL-52, it helps to release emotions from the chest, and with fei shu BL-13 and shen zhu GV-12, it treats thoughts or fear of death. ● Zhi shi BL-52: strengthens willpower and stimulates memory (in older patients); treats fear of change (fear of life), difficulty moving into action, and being blocked by emotions. Combine with shen shu BL-23 and hun men BL-47 for severe depression. Combine with da zhu BL-11, xuan zhong GB-39, and du mai (SI-3/ BL-62) to strengthen character. In general when treating emotions, if there is an underlying vacuity of yin or blood, I recommend supplementing the back transport (shu) point and releasing the zhi point (inner and outer bladder channel lines): ● In cases of irritability and anger with liver blood vacuity: supplement gan shu BL-18 and drain hun men BL-47. ● In cases of worry or obsessive thinking with spleen qi vacuity: supplement pi shu BL-20 and drain yi she BL-49. ● In cases of fear from kidney qi vacuity: supplement shen shu BL-23 and drain zhi shi BL-52. In case of emotional manifestations from repletion of qi, the ying (spring) and shu (stream) points should be used: ● In case of intense anger or rage from liver fire: drain xing jiang LR-2 and tai chong LR-3.

Etiology and Treatment of Insomnia

●

In case of overexcitement and manic behavior from heart fire: drain shao fu HT-8 and shen men HT-7.

I have noticed that the five zhi points are excellent indicators of emotional patterns, as the points become tight and tender on palpation. Quite often, even if the patient is not able to accurately identify the emotional pattern, the sensitivity of these points can reveal the true underlying emotion. Other Points Affecting Shen ● Shen men HT-7 for depression, anxiety, insomnia, hysteria, loss of memory, retardation ● Shen dao GV-11 for sadness, fear, amnesia, regrets ● Shen ting GV-24 for severe anxiety, mania, hysteria, nightmares ● Shen feng KI-23 for mental restlessness, anxiety when lying down ● Shen cang KI-25 for insomnia, mental restlessness, negativity, waking up in a bad mood ● Shen ting GV-24 with ben shen GB-13 for anger, anxiety, or depression. Another Strategy for Dealing with Emotions The luo (connecting channels), with their network of blood capillaries, act as a buffer against the outer world. Both emotions and external pathogenic factors are maintained in the luo in an attempt to prevent them from penetrating deeper into the zang fu. Bleeding the luo of the yangcoupled channel helps to release the emotional pattern: ● For habitual irritability, frustration, anger, or hate, bleed guan ming GB-37. ● For overexcitement or excessive craving (desire), bleed zhi zheng SI-7. ● In obsessive patterns and worry, bleed feng long ST-40. ● For sadness, grief, and melancholia, as well as anxiety about the future, bleed pian li LI-6. ● For fearfulness and chronic anxiety, bleed fei yang BL-58. All the luo involve the blood mansion, the heart and pericardium. The strategy also calls for helping to circulate the heart qi with nei guan PC-6, to open the chest, as well as opening the Great Luo of the Spleen (da bao SP-21).

Wang Qing-Ren in Yi Lin Gai Cuo (Correcting the Errors in the Forest of Medicine), 1830, recommends the use of ji quan HT-1, da bao SP-21, and zhang men LR-13 to treat insomnia (all three points should be needled obliquely toward the front). To Calm the Shen Insomnia is by definition a condition in which the shen is unsettled or overactive. In all treatment principles, be it using acupuncture or herbs, the shen needs to be calmed. According to Master Yuen, there are three terms that correspond to three strategies for dealing with shen disturbances. Acupuncture points are classified according to their actions on the shen: ● An (calm). Calming involves qi, especially heart qi. The strategy is to help move wei qi inward. All the points along the shou shao yin (heart) channel, especially shen men HT-7 or tong li HT5, can be used, as well as shou tai yin (lung) channel points, including tian fu LU-3, tai yuan LU-9, or yu ji LU-10, may be indicated. Zhao hai KI-6 (when bled) and feng long ST-40 also calm the shen. ● Qing (quiet). Quieting involves blood, mainly liver blood, which helps soothe or quiet the shen. Points that quiet the shen cannot really function if blood is deficient: the shou jue yin (pericardium) channel points jian shi PC-5, da ling PC-7, and xi men PC-4 need sufficient blood and require the addition of qu quan LR-8 or other blood supplementing points such as ge shu BL-17 or qi chong ST-30. Shen men HT-7 also calms the shen. ● Ding (settle). Settling or stabilizing involves kidney yin or lung yin. The kidneys help to grasp, or anchor, the heart qi to settle the shen and calm the mind. Some common settling points include yong quan KI-1, yin bai SP-1, and chi ze LU-5. Besides these direct actions on the shen when the shen disturbance is caused by heat, a qing (clearing) strategy can be used, that is, li dui ST-45. Generally speaking, when emotions affect the shen, the treatment strategy should be chosen according to the emotion: ● Calm the shen: for issues involving anxiety, joy, or nonfulfillment affecting heart qi

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● ●

Quiet the shen: for patterns involving worry (spleen) or anger (liver) Settle the shen: in cases of grief (lung) or fear (kidney)

As mentioned above, each emotion will affect the heart in a different way: ● Anger will cause heart fire: use lao gong PC-8 and shao fu HT-8. ● Joy and sadness affect heart qi: use shen men HT-7. ● Pensiveness affects heart blood: use da ling PC-7 and tong li HT-5. ● Fear and fright or shock in adults affects heart– kidney communication: use xi men PC-4 with xin shu BL-15, gan shu BL-18, and pi shu BL-20.

Extraordinary Vessels Chapter 2 explored in detail the central role of the eight extraordinary vessels, in particular the yin qiao mai (motility or stepping vessel) and wei mai (linking vessel). Insomnia caused by the first four extraordinary vessels, which are referred to as the “first ancestry,” is, however, more rare than insomnia caused by the second four extraordinary vessels: ● Du mai (governing vessel): – Yang repletion: excitability, irritability, insomnia, a painful and tight spine with heat in the middle, high fever, overreactivity (allergy) – Yang stasis: insomnia; headaches, stiff neck; red eyes, eye pains – Treat both by reducing hou xi SI-3, shen mai BL-62, zhi yang GV-9, and bai hui GV-20 (and use other du mai points too, such as ling tai GV-10, tao dao GV-13, nao hu GV-17, qiang jian GV-18, hou ding GV-19, and xin hui GV-22). ● Ren mai (conception vessel): – Yin vacuity: insomnia, mouth dryness, thirst at night; menopausal syndrome; patterns of blood vacuity or jing vacuity – Treat by supplementing lie que LU-7, zhao hai KI-6, guan yuan CV-4, qi hai CV-6, yin jiao CV-7, and jiu wei CV-15 ● Chong mai (penetrating vessel): – A counterflow qi causing the sensation of qi rushing up, “running piglet” syndrome

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(panic attacks), insomnia with a hot head and cold feet, dizziness, nausea, vomiting, dyspnea, and chest oppression – Treat with gong sun SP-4 and nei guan PC-6; add tai chong LR-3, da ling PC-7, and the kidney channel points on the chest, especially shen feng KI-23, ling xu KI-24, shen cang KI-25, or yu zhong KI-26 Dai mai (belt or girdling vessel): – Yang stasis in the upper body with deficiency in the lower body: insomnia, pruritis of the head, headaches, a sensation of sitting in water and weakness of the legs, belt-like lumbar pain – Treat with zu lin qi GB-41, dai mai GB-26, wei guan TB-5; also xuan zhong GB-39 (helps to balance excess in the upper body)

The second- and third-ancestry extraordinary vessels are more involved with regulating the internal rhythms and synchronizing the zang fu physiology with external changes. The disturbances of the yin and yang wei and qiao vessels can cause sleep difficulties in specific segments of the night, as explored in the section above on “Diagnosing Insomnia,” which can be confirmed by palpating their xi points: ● Jiao xin KI-8 on the yin qiao vessel ● Fu yang BL-59 on the yang qiao vessel ● Zhu bin KI-9 on the yin wei vessel ● Yang jiao GB-35 on the yang wei vessel ● Yin qiao mai (motility or stepping vessel): – Vacuity: insomnia, headaches, pain (worse at night); convulsions; weakness or paralysis of the legs; blurred vision, difficulty opening the eyes; anuria, spermatorrhea, impotence, sterility, menstrual cycle problems – Treat with zhao hai KI-6, jiao xin KI-8, lie que LU-7, jing ming BL-1 (or yin tang) ● Yang qiao mai (motility or stepping vessel): – Repletion: insomnia, headaches (worse at night); lumbar pain, one-sided pain or weakness; pain and tightness (not localized; worst at night), lateral leg and hip pain and spasticity; internal or external wind: convulsions, tinnitus, epilepsy, Parkinson disease; nose bleeds; red and painful eyes, exophthalmia – Treat with shen mai BL-62, fu yang BL-59, hou xi SI-3, jing ming BL-1 (or yin tang), and possibly feng chi GB-20

Etiology and Treatment of Insomnia

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Yang wei mai (yang linking vessel): – Repletion: alternating fever and chills, sensitivity to changes in the weather; insomnia with easy waking; chest oppression; changing moods; pain, and spasms, lumbar pain; skin hyperesthesia, arthralgia (hand, heel); parotiditis; diarrhea; headache with heat or storm; red or tearing of the eyes (with wind); otitis, deafness, tinnitus; acute sinusitis; facial neuralgia; eczema of the neck or ears – Treat with wei guan TB-5, zu lin qi GB-41, yang jiao GB-35, ben shen GB-13 Yin wei mai (yin linking vessel): – Vacuity: insomnia from fear, vacuity of the heart and lung, palpitations, heart pains, hypotension; ptosis; depression, tears, oversensitivity – Treat with nei guan PC-6, gong sun SP-4, zhu bin KI-9.

Insomnia Due to Seasonal Desynchronization Dr. Michel Frey (personal communication) has a slightly different approach to insomnia. He explains the sleeping process in relation to three phases: ● Falling asleep. This phase corresponds to progressive relaxation and letting go of consciousness. In energy terms, this corresponds to shao yin, as manifested in the slowing down of the cardiac rhythm and mental quieting (heart) and articular relaxation (kidney). As shao yin governs “letting go,” all types of fears, especially the fear of death, will more easily manifest at this stage. A vacuity of kidney qi or kidney yin causes the heart yang to become overactive, with the consequence that a state of mental agitation alternates with initial drowsiness. This type of insomnia is frequently witnessed at the summer or winter solstices. The treatment protocol calls for unbinding the shao yin using the xi points shui quan KI-5 and yin xi HT-6, with the addition of ju que CV-14 to release the accumulation of qi in the chest. ● Deep sleep. During this phase, there is a loss of muscle tone and, according to Chinese medicine, the eyes turn inward to engage in the dream vision. In energy terms, this phase is

●

controlled by jue yin (the liver and pericardium), and corresponds to the time between 2 a.m. and 4 a.m. Since jue yin is the intermediary between tai and shao yin and helps move yin in and out, sleep alternates between deep sleep and REM sleep. Palpitations, anxiety, or possibly heat with a need for cool drinks (liver heat) often accompany waking up at this time. This type of insomnia is most often observed during the spring or autumn equinox. The treatment consists of draining tai chong LR-3, nei guan PC-6, and yu tang CV-18. Intermediary sleep, or the terminal phase of sleep. This phase corresponds in energy terms to the exit of yin toward the yang, that is, the passage of tai yin toward yang ming (brightness). It is the first regaining of consciousness during which the mind may occupy itself with the forthcoming activities of the day. This worry, concern, or anticipation of the coming day can be responsible for this type of terminalphase insomnia. It may also be observed during the period between the seasons, representing the passage between one situation and another. The treatment aims to help the opening or exit of yin toward yang: use zhong fu LU-1, chong men SP-12, with the addition of yi she BL-49 to help reduce the cogitation and pensiveness.

Although this classification of the three phases of sleep seems different to the one I proposed previously in the chapter, it is another way of looking at sleep which definitely has its place in this book as it has proved its efficacy over the years.

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Acupuncture Points Affecting Sleep

Ling xu KI-24

Constituent point of chong mai, ling point: psychological stress, anxiety; doubting, suspicion, sensation of having two opposing wills; reduced memory; needing to swear, obsessions. As a ling point, helps to let go of the past and to forgive

Shen cang KI-25

Constituent point of chong mai, corresponds to the middle Cinnabar Chamber: insomnia from worry, restless mind; depression, disliking life, seeing the negative aspect of things

Yu zhong KI-26

Constituent point of chong mai, inward movement point of shao yin: insomnia, waking in a bad mood, easily angry; feeling of not being loved; fearful spirit, touchy; concentration and memory problems Constituent point of chong mai, connection with CV-23 and PC-1: persistent insomnia, agitation; apprehension, expecting a misfortune; jumpy, irritable; headaches from mental effort

Heart-Shou Shao Yin and Kidney-Zu Shao Yin Channels Shen men HT-7

Yuan (source), shu (stream), and earth point; draining (sedation) point: quiets and calms the shen, all insomnia, frequent waking, excessive dreaming, agitation, sleep-talking; hysteria, psychosis, running around; hallucinations; lack of memory, mental retardation in children; mental anorexia, mental dullness

Shao fu HT-8

Ying (spring), fire, and pen (element) point: mental restlessness, mania, hysteria, schizophrenia; emotionality, fear of people; sighing; insomnia, mental restlessness

Yong quan KI-1

Jing (well) and wood point; draining (sedation) point; strong sinking action, stabilizes the shen: hysteria, anxiety with palpitations, insomnia, fright wind, very visual dreams; shyness, refusal to speak, fearfulness; forgetfulness; overemotionality; mental confusion; excessive willpower; loss of desire for food

Shu fu KI-27

Tai xi KI-3

Yuan (source) and earth point: stabilizes the emotions, regulates the will; insomnia; fear

Pericardium-Shou Jue Yin and Liver-Zu Jue Yin Channels

Zhao hai KI-6

Key (opening) point of yin qiao mai insomnia with agitation (bleed), irregular menstrual cycles; sadness, hysteria, sense of unease but cannot localize the pain

Jiao xin KI-8

Xi (accumulation) point of yin qiao mai, mobilization point of yin in the legs: no sense of identity; schizophrenia; lack of trust in oneself

Zhu bin KI-9

Starting and xi point of yin wei mai, unstable, capricious, or discontented character; fear, anxiety, restlessness, paranoia; schizophrenia, depression; hysteria, tongue sticking out, drooling

You men KI-21

Shen feng KI-23

Constituent point of chong mai, specific organ point of the liver (stores and circulates blood): anxiety, depression, amnesia, anger, moodiness, better with movement; tiredness but cannot sleep; infants need to be carried all the time Constituent point of chong mai, specific organ point of the heart (blood circulation and production co-coordinator): restless mind, anxiety when lying down

Tian chi PC-1

Window of the Sky point, mobilization point of blood in the head, meeting point of jue yin: liver and pericardium channels; regulates blood: restlessness

Xi men PC-4

Xi point; barrier point of descending yin of the elbow: quiets the shen, rectifies qi, deals with guilt and shame, loss of memory, fear of people, claustrophobia, melancholia, hysteria

Jian shi PC-5

Metal, jing (river) point; use group-luo meeting points of the upper yin: brings yin to the upper body: insomnia, night terrors; use with PC-7 in menopause; insecurity, shyness in children; needing to move all the time; hysteria, psychosis; hallucinations (seeing ghosts); infantile crying

Nei guan PC-6

Luo point; key point of yin wei mai, command point of the upper burner and chest: rectifies qi, deals with guilt and shame, fright wind, convulsions; forgetting words, indecision; laziness; stress, anxiety with palpitations, insomnia, hysteria

Etiology and Treatment of Insomnia

Da ling PC-7

Lao gong PC-8

Yuan, shu (stream), and earth point; draining (sedation) point; quiets the shen, opens the chest: insomnia, anxiety, fear, panic, grief; use with PC-5 in menopause; weeping, sadness with hysterical laughter; insomnia; anxiety; indignation, discontent, depressions; helps to detach when dying or in mourning Ying (spring), and fire and pen point: shyness, anxiety and depression, discontent; mental restlessness, mania, hysterical laughter, anxiety, cannot sleep at all

Zhong chong PC-9 Jing (well) and wood point, supplementing point: night crying in children, fear of the dark, anxiety, amnesia Xin jian LR-2

Ying (spring), fire point, draining (sedation) point: depression, sighing, desire to die, easily moved to tears; seeing ghosts, fear; nervous palpitations, anger; insomnia, manic behavior

Tai chong LR-3

Shu (stream), yuan point; guan (barrier) point (mobilization and distribution of qi), earth point, constituent point of chong mai, blood purification point: repressed emotions, insomnia, nervousness, irritability; fright wind in children

Qu quan LR-8

He (sea), water point, supplementing point: restless legs syndrome (RLS)

Zu wu li LR-10

Local mobilization point: insomnia

Tai yuan LU-9

Yuan (source) and shu (stream) point, hui (meeting) point of vessels, earth point, supplementing point of lung; command point of qi emotional outbursts, insomnia from overexcitement, nervous pains; vulnerability from guilt or embarrassment

Yu ji LU-10

Ying (spring) and fire point; clears lung heat: insomnia, grief; anxiety, nervous trembling; madness

Shao shang LU-11

Jing (well) and wood point: insomnia in children, sleeping with half-open eyes

Yin bai SP-1

Jing (well), wood point; stabilizes shen: restless sleep, excessive dreaming, mental agitation, nightmares; infantile shyness or fear; meningitis, convulsions, coma, grief, melancholia, ghost oppression

Da du SP-2

Ying (spring), fire point, supplementing point: lack of morality, of discipline, or of emotional control, mental tiredness, lack of concentration or of synthesis; friendly but egotistical, tactless, people who accumulate, superficial, cannot think ahead; worry, obsessive thinking, insomnia, anxiety, depression; dreams of narrow rocky passes or of ruins in the rain

Tai bai SP-3

Yuan (source), earth point, pen point: agitation, heavy head, confusion; laziness upon waking

Gong sun SP-4

Luo point, key point of chong mai Sea of Blood, the Mother of the 12 Channels, rectifies qi insomnia, restlessness, judgment issues related to moral and sociocultural values, manic depression

Shang qiu SP-5

Jing (river), metal point, draining (sedation) point: pessimism, worry about the future, agitation, depression with sighing, obsessions; altruism, masochism; nightmares; hysteria, convulsions (from excess insulin), epilepsy, children who need to be carried

San yin jiao SP-6

Group-luo point of the spleen, liver, and kidney channels, crossing of yin wei mai, regulates qi, blood, and jing: insomnia from fatigue, nocturia; shyness in children; neurasthenia

Di ji SP-8

Xi point: feeling of dropping when falling asleep, dreams of falling or sinking

Lung-Shou Tai Yin and Spleen-Zu Tai Yin Channels Zhong fu LU-1

Mu (collecting; alarm) point, connecting with spleen and liver channels, inward movement of yin: insomnia, waking at 3 a.m., puffy face in the morning

Yun men LU-2

Distribution of ying qi from the chest, complementary, yin exteriorization from the chest: insomnia, waking at 3 a.m.

Tian fu LU-3

Window of the Sky point, controls the balance of qi and blood of the head: depression, anxiety, loss of memory, confusion, talking to oneself, claustrophobia, restless sleep, ghost talk (sleeptalking), feeling of an external presence, excessive crying from sadness, waking with puffy eyes

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Large Intestine-Shou Yang Ming and StomachZu Yang Min Channels

Small Intestine-Shou Tai Yang and Bladder-Zu Tai Yang Channels

Er jian LI-2

Ying (spring), water point, sedation point: tendency to fall asleep

Hou xi SI-3

San jian LI-3

Shu (stream), wood point: extremely emotional, likes to lie down

He gu LI-4

Yuan (source) point, guan point, mobilization and distribution of qi anxiety, restlessness, influences the quality of sleep, insomnia from weakness; dreams of flowers or landscapes

Shu (stream) point; wood point; supplementing point; key point of du mai hysteria, mania, insomnia, dream-disturbed sleep; dream of narrow passages; chronic mental weakness and depression

Jing ming BL-1

Constituent point of yang and yin qiao mai; connection with small intestine (SI-18), stomach (ST-1), and liver channels (LI-20), bladder–sinew channel, and heart, small intestine, spleen, and stomach jing bie (divergent) channels; jie (termination or knot) point of tai yang (channel): insomnia or sleepiness, intellectual fatigue

Zan zhu BL-2

Barrier of ascending yang: nightmares, overexcitement, hallucinations

Tian zhu BL-10

Meeting of yang and yin qiao mai, Window of the Sky point: brings yang down from the head; barrier of descending yang: frozen by emotions; fear of heights; insomnia (from overwork); nightmares; sexual dreams, lack of coordination, lack of memory and concentration; neurasthenia, schizophrenia, sexual overstimulation

Xin shu BL-15

Back shu (transporting) point of the heart; control point of qi and blood circulation in the upper parts: nocturnal enuresis in children; depression, loss of memory; fear, stage fright; irritability, anxiety, dream-disturbed sleep, dreaming of the dead, sexual dreams, spermatorrhea; hallucinations, hysteria, mania

Pi shu BL-20

Back shu (transporting) point of the spleen pancreas: light sleep; anxiety, depression, sadness

Gao huang shu BL-43

Regulates thoracic blood and qi, huang point, relative to autonomous nourishment; Sun Si Miao’s point of “hundred diseases”: depression, neurasthenia; loss of memory, insomnia, anxiety; hysteria, overexcitement; doubts; nutritional problems

Shen tang BL-44

Palace of shen: depression, disorientation, insomnia, anxiety; mania

Yi xi BL-45

Sighing point; insomnia from fatigue, sweating from shock

Qu chi LI-11

He (sea) point, earth point, supplementing point: depression, fear, forgetfulness, dreams of untilled fields

Shou wu li LI-13

Helps the inward movement of yang: worry, fear, likes to lie down

Que pen ST-12

Gathering point where qi descends, crossing of liver, small intestine, triple burner, and gallbladder channels: anxiety, dislike of tightness around the neck, insomnia from nervousness

Liang men ST-21

Special organ point of the stomach: insomnia after midnight, needs to eat to fall asleep

Da ju ST-27

Brings thoracic yang down, moves pelvic qi: fright, anxiety, nervousness, infertility from stress, insomnia from worry

Zu san li ST-36

He (sea) point, earth point, pen point; Sea of Nourishment point, distribution of ying qi (nourishing qi) and xue: all psychiatric diseases, insomnia, weakness from emotion

Feng long ST-40

Luo point; command point of the mucous membranes, clears hot phlegm: tightness in the solar plexus, anxiety, dizziness; phobia, schizophrenia; the compulsion to climb to high places to sing, or to undress and run around madly, for example; hallucinations

Nei ting ST-44

Ying (spring) and water point: nightmares, restless extremities at night; desire for silence

Li dui ST-45

Jing (well) and metal point, draining (sedation) point: jumpiness, hypersensitivity; dream-disturbed sleep, nightmares, sleepiness

Etiology and Treatment of Insomnia

Hun men BL-47

Hun gate: depression, irritability, anger, resentment, frustration; anxiety, vague feeling of fear at night, paranoia; lack of direction or ideas, lack of roots; unable to let go of the past

Kun lun BL-60

Jing (river) and fire point: insomnia from emotions, infantile insomnia teething pain in infants; pain, discontent, or irritation; uterine blood stasis, from fear or sexual abuse; helps to surrender in the dying person

Shen mai BL-62

Key (opening) and starting point of yang qiao mai, command point of the “Gate of the Ankles”: introversion; insomnia (drain); somnolence and dull spirit (supplement); depression, amnesia, disorientation, mania, obsessions; delirium

Xin shu BL-15, Gan shu BL-18, Pi shu BL-20

Insomnia from xue vacuity, superficial sleep

Triple Burner-Shou Shao Yang and Gallbladder-Zu Shao Yang Channels Guan chong TB-1

Jing (well) and metal point: agitation, insomnia, tightness in the throat

Wei guan TB-5

Luo (connecting) point, key point of yang wei mai sleep cycle disturbance, jet lag (with he gu LI-4)

Tian jing TB-10

He (sea) and earth point, draining (sedation) point: difficulty falling asleep, insomnia from sadness; melancholia (with GV-11, BL-15); palpitations; emotional skin rashes; repressed worry; depression, anxiety; pushing oneself too hard; hypertension; insanity

Tian yu TB-16

Window of the Sky, mobilizes yin: restless dreams, dreams of falling or standing on one’s head

Lu xi TB-19

Regulates the sensory functions: insomnia, fear, restless legs syndrome (with TB-2)

Si zhu kong TB-23

Helps yang flow forward: tightness in the throat and solar plexus, fear, restless sleep, nervous jerking at night; mania

Ting hui GB-2

Mobilizes yang from back to front: insomnia after 3 a.m.; eating quickly, lack of joy, false ideas

Han yan GB-4

Connection with the triple burner, stomach, and liver channels; yang mobilization point: calms fear and pain, infantile fears, night terrors

Shuai gu GB-8

Connection with bladder channel, mobilization of yang from inside to outside and downward: calms fear, all dependencies (with GB-9), withdrawal syndrome, alcohol detox; lack of willpower; oral complex

Wan gu GB-12

Connection with bladder channel: insomnia, aphasia, mania

Ben shen GB-13

Constituent point of yang wei mai, command point of the extraordinary fu, controls contact to the world: insomnia, excessive dreaming, nightmares, anxiety, fixed ideas, paranoia, jealousy; schizophrenia; fever from emotions, depression

Tou lin qi GB-15

Constituent point of yang wei mai. Connection with the bladder and triple burner channels: unstable emotions, easily frightened, trembling or stiffness from shock, depression, insomnia, anxiety, nightmares

Zheng ying GB-17

Constituent point of yang wei mai, helps diffuse lung qi insomnia, agitation

Feng chi GB-20

Constituent point of yang wei and yang qiao, mobilizing point of qi and blood of the head and the neck, major wind point: insomnia, irritability, mania

Zhe jin GB-23

Mu (collecting, alarm) point of the gallbladder channel (along with GB-24); yang exteriorization point: insomnia from overwork, infantile night fright; amnesia, indecision

Ri yue GB-24

Mu point of the gallbladder channel (along with GB-23); yang exteriorization point: alternating joy and sadness; sighing; hysteria with excessive talking; indecision; somnolence

Xia xi GB-43

Ying (spring) and water point, supplementing point: insomnia from fear and insecurity, humiliating dreams; worry, lack of courage, putting things off

Zu qiao yin GB-44

Jing (well) and metal point: agitation, insomnia with excessive dreaming, nightmares

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Du Mai-Governing and Ren Mai-Conception Vessels Xuan shu GV-5

Moves yang up and down: always in a hurry, impulsive, dreaming of snakes

Ling tai GV-10

Ling (soul) point, perception of danger: problematical introspection, insomnia

Tao dao GV-13

Connection with BL-10, BL-11, BL-12: insomnia from fatigue, shyness, seeking solitude, lack of joy

Nao hu GV-17

Connection with the bladder channel, Sea of Marrow point and connection to the brain; mobilizes blood on the surface: mania, hysteria, insomnia before midnight

Qiang jian GV-18

Connection to the brain: hysteria, insomnia

Hou ding GV-19

Connection to the brain: insomnia, severe anxiety

Bai hui GV-20

Connection with all the yang channels, end of the liver channel, meeting of all jing bie (divergent) channels; Sea of Marrow point (with GV-16 and GV-17), connection to BL-1 and GB-8; brings qi, yang, yin, and blood to the head: depression; anxiety; mania hysteria; insomnia; lack of will to live, loss of reality, false ideas

Xin hui GV-22

Mobilizes yin and blood in the head: mental confusion, dyslexia, fright, insomnia, lack of imagination

Shen ting GV-24

Meeting with bladder and stomach channels: schizophrenia, severe anxiety (with GB-13), mania, hysteria

Guan yuan CV-4

Meeting of spleen, liver, and kidney channels, mu point of small intestine; birth and mobilization of yin: anxiety, insomnia, night fears, shock

Qi hai CV-6

Center of human physical qi, Sea of All the huang (vital) points: depression, lack of willpower, alcoholism; no desire to live, insomnia

Jiu wei CV-15

Luo point of ren mai, command point of the sexual organs, source of the five zang: depression, difficulty finding words, boredom, feeling of doom; absentmindedness; anxiety; mania; hysteria, insomnia

Extra Points for Insomnia Yin Tang (EX-HN-3) Location On the glabella, between the eyebrows (Fig. 3.7). Actions Benefits the nose; dispels wind; alleviates pain; calms the shen. Indications Insomnia, to calm the mind; nose and eye diseases, dizziness, hypertension; infantile convulsions (fright wind) Yi Ming/An Mien (EX-HN-54) Location In spite of the different nomenclature, I believe them to be at the same point as they are described with the same location: on the lower border of the mastoid, on the sternocleidomastoid muscle, midway between yi feng TB-17 and feng chi GB-20 (slightly posterior and superior to wan gu GB-12) (Fig. 3.8). Actions Calms the shen; regulates the liver. Indications Insomnia, sensitivity to external factors, agitation and restlessness; eye diseases; tinnitus

Yin tang

Fig. 3.7 Yin tang for insomnia and to calm the mind.

Etiology and Treatment of Insomnia

1/2

1/2

GB-20 Yi ming (An mien)

GB-12 GB-20

GB-12 TB-17

TB–17 An mien I Yi ming (An mien) An mien II

Fig. 3.8 Yi ming or an mien (EX-HN-54) for insomnia from sensitivity to outer stimuli.

An Mien I (EX-HN-52) and An Mien II (EX-HN-53) Location An mien I: on the lower edge of the mastoid, on the sternocleidomastoid muscle midway between yi feng TB-17 and yi ming EX-HN-54. An mien II: between yi ming and feng chi GB-20 (Fig. 3.9).

Fig. 3.9 An mien I and II for insomnia and sleep-walking.

Actions Calms the shen; benefits ears and eyes. Indications Insomnia, sleep-walking; nervousness, psychosis; headaches, convulsions; palpitations. Si Shen Cong (EX-HN-1) Location On the vertex, 1 Cun away from bai hui GV-20 anterior, posterior, left and right (Fig. 3.10). Actions Calms the shen; dispels wind; benefits the eyes. Indications Insomnia; stroke (apoplexy); epilepsy; headaches; dizziness; eye diseases; pruritis.

GV-20

1 Cun 1 Cun

EX-HN-1 Si shen cong

Fig. 3.10 Si shen cong (EX-HN-1) for insomnia and pruritis.

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Ear Acupuncture Shen Men

Endocrine Hormones/Internal Secretion/ Hypophysis/Pituitary Point

Location At the tip of the triangular fossa.

Location At the lower extremity of the intertragic incisure.

Actions Alleviates pain, calms the shen, reduces inflammation.

Actions Controls hormonal secretions, maintains homeostasis.

Indications Pain, tension, anxiety, depression; hypertension; insomnia; pruritis; vertigo; hypertension; epilepsy; all addictions (Fig. 3.11)

Indications Antirheumatic, anti-inflammatory, antiallergic; resolves dampness: edema, obesity, and eczema; urogenital and digestive problems (malabsorption).

Sympathetic/Autonomic Point Location Under the helix, on the extremity of the lower branch of the antihelix. Actions Regulates the sympathetic and parasympathetic nervous systems, regulates vasodilatation, inhibits secretions. Indications Alleviates pain; intestinal spasms, stomach hyperacidity; tachycardia; hyperthyroidism, stress; asthma; Raynaud disease, vascular diseases; dermatitis; amenorrhea, dysmenorrhea; eye problems; drug addiction.

Master Cerebral Point/Master Omega Point/ Psychosomatic Point Location On the ear lobe, in the mid-anterior section. Actions Analgesic, calming; psychosomatic symptoms. Indications Fear, worry, nervousness, negative thinking, obsessive–compulsive disorder; chronic pain, emotional stress; sleeping disorder: dream-filled sleep, light sleep, easily awakened with difficulty falling asleep again. Tranquilizer/Relaxation Point Location Lower third and anterior part of the tragus.

Insomnia 1

Insomnia 2 Temple Endocrine

Shen Men Sympathetic

Relaxation (Tranquilizer) Omega (Master Cerebral)

Actions Relaxes, calms the mind, reduces tension. Indications Muscle tension, restlessness, nervous tension, insomnia, hypertension. Insomnia 1 and Insomnia 2 Points

Fig. 3.11 Auricular points for insomnia (Chinese and French schools).

Locations Insomnia 1. In the upper part of the scaphoid fossa (between the helix and the antihelix), below the darwinian tubercle.

Etiology and Treatment of Insomnia

Insomnia 2. In the lower part of the scaphoid fossa, level with the antitragal groove (junction of antihelix and antitragus). Actions Benefits sleep; calms the shen. Indications Insomnia.

Some Classical Acupuncture Point Combinations The following point indications are compiled from source texts such as the Huang Di Nei Jing (Inner Classic of the Yellow Emperor) (ca. 100 BCE), Zhen Jiu Jia Yi Jing (Systematized Classic of Acupuncture and Moxibustion) (ca. 282 CE), Bei Ji Qian Jin Yao Fang (Essential Formulas Worth a Thousand in Gold) (ca. 625), Bei Ji Qian Jin Yi Fang (Supplement to the Essential Formulas Worth a Thousand in Gold) (ca. 682), Bai Zheng Fu (Ode of One Hundred Patterns) (1529), and Zhen Jiu Da Cheng (The great Compendium of Acupuncture and Moxibustion) (1601). The point indications were mainly cited by authors such as G. Soulié de Morant, E. Rochat de la Vallée, J.-M. Kespi, and Daoist Master J. Yuen.

Waking to eat

Hui zong TB-7

Disturbing dreams

Tian you TB-16

Sexual dreams

Shen shu BL-23

Sleep-talking

Shen men HT-7

Ghost talking

Tian fu LU-3

Ghost oppression

Yin bai SP-1

Excessive dreaming

Yin bai SP-1

A lot of dreams

Xin shu BL-15, pi shu BL-20, gan shu BL-18

Nightmares

Shen ting GV-24 with ben shen GB-13

Dreams of death

Zu qiao yin GB-44 with shang qiu SP-5

Dreamy state

Da zhui GV-14, quqi LI-11, yang ling quan GB-34, guan yuan CV-4, and shen que CV-8

Wandering hun

Hou ding GV-19, jiu wei CV-15

With chest oppression

Yin bai SP-1, li dui ST-45

Anxiety

Shen ting GV-24 (or bai hui GV-20) with jiu wei CV-15

Mind obstructed

Qiang jian GV-18, zheng ying GB-17, cheng ling GB-18

Tossing and turning

Xing jian LR-2, tai chong LR-3

Light sleep

Gan shu BL-18, qu quan LR-8

Cannot sleep at all

Lao gong PC-8, da ling PC-7

Insomnia in children

Shao shang LU-11

Insomnia in menopause

Da ling PC-7, jian shi PC-5

Difficulty falling asleep

An mien (EX-HN-54)

Modern point combination Shen men HT-7, san yin jiao for all types of insomnia SP-6, with si shen cong (EX-HN-1) or an mien (EX-HN-54), or yin tang (EX-HN-3)

Qi Gong for Insomnia The Daoist physician Ge Hong (3rd century) proposed a set of exercises to treat insomnia: 1. Lie in a supine position with the knees bent. Use the hands to pull the knees toward the chest, breathing normally. Hold the position for 1 minute, then straighten the legs, relax the arms and hands and bring them to the sides. 2. Still in a supine position. Both arms are stretched up and above the head while inhaling. While exhaling, bring the hands down to the chest and massage from the chest to the abdomen. Then relax the arms and hands and bring them back to the sides. Repeat several times. 3. Still in the same position, make the hands into fists and place them under the back, one fist on either side of the spine, as high as possible toward the shoulder blades. Take three deep breaths, and then move the fists downward a few inches and repeat the deep breathing, moving down until the fists are at waist level. Five deep breaths are taken here. The fists are then moved to either side of the tailbone and another five breaths are taken. 4. Lying face down, place the hands under the belly. Inhale and exhale slowly, pausing after each exhalation, relax all the muscles, and let go of all mental and emotional tension. Repeat several times. 5. The sleep position: the Daoist Deer Sleeping Posture, which is very similar to the Lion Posture in Buddhism. Lying on the right side, bend

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the right arm at the elbow, with the palm facing up in front of the face. The left arm rests on the side, and the elbow on the left hip, with the hand hanging in front of the abdomen. The right leg is straight, and the left knee is bent, resting on the bed in front of the right thigh.

Overview of Treatment Strategies The initial assessment should aim to: ● Establish the type of insomnia: mental agitation or physical (visceral) restlessness, or both ● Establish which phase of the night sleep is affected: initial, middle, or end ● Identify and diagnose whether one of the four extraordinary vessels responsible for synchronizing sleep and waking time is affected. This helps to identify the zang fu patterns involved and helps select the channels to be treated ● Identify any substance disharmony, in particular blood vacuity or yin vacuity ● Establish the presence and type of emotion ● Identify the zang fu patterns ● Explore the dreams. This may help identify the zang fu pattern, but mainly mental and emotional issues. In most cases of insomnia due to time adjustment, as in jet lag or shift work, or any recent insomnia with no apparent substance or zang fu disharmony, especially if jiao xin KI-8 or fu yang BL-58 is reactive to palpation, I often begin treatment with the following combination of points: ● Zhao hai KI-6 (supplement on the dominant side: right for women, left for men) ● Shen mai BL-62 (reduce on the opposite side) ● Yin tang EX-HN-3 ● This point combination is very often sufficient to regulate sleep with one or two sessions, 3–4 days apart. In more complex insomnia patterns, there may be a substance disharmony, most often xue vacuity or yin vacuity, as well as an emotional disturbance. The treatment principle is then to pacify the shen, supplement the vacuity, and release the emotion. Identifying an extraordinary vessel helps to select the involved yin channels (tai yin, shao yin, or jue yin), and to choose the best points for dealing with the shen disturbance.

Where possible, I try to treat a patient twice a week, but I do not treat the extraordinary vessels more than once a week. In long-standing cases of insomnia, several months of treatment are necessary. In these conditions, some dietary advice, like avoiding stimulants (see Chapter 1) or avoiding yang-producing foods and drinking at night, as well as good sleep hygiene is important. Appropriate Chinese herbal treatments certainly help to improve the chances of success. Patients who are used to taking pharmacological substances to induce sleep should try to progressively reduce the dose and frequency in order to avoid the rebound effect. Simple Western herbal teas should be tried out when replacing medication. There are many on the market, the most common being: ● Chamomile tea: a teaspoon of dried chamomile flowers, or two chamomile teabags per cup of water with honey (calming) ● Chamomile and valerian root (for anxiety) ● Valerian root and lavender ● Chamomile (1 teaspoon), vervain leaves (1 teaspoon), and spearmint (half a teaspoon) ● Chamomile, valerian root, and linden flowers (Tilia) ● Hypericum, or St. John’s Wort, which has wellknown antidepressant and anxiolytic effects ● Digestion-promoting teas such as peppermint (some patients may be stimulated by peppermint), fennel, lemon balm, and chamomile ● Passionflower (Passiflora incarnata) for anxiety, when stopping antianxiety medication ● Green tea should be substituted for coffee as it contains the amino acid L-theanine (which increases the activity of the neurotransmitter GABA), promoting relaxation and reducing anxiety. However, green tea should be avoided in the afternoon and evening. According to the Mayo Clinic, the use of light therapy, for instance using artificial light to simulate natural sunlight, helps to correct the body’s circadian rhythms and may be proposed for conditions such as jet lag, sleep disorders, and seasonal affective disorders (SAD) (Mayo Clinic 2010). Other studies show that phototherapy devices produce melatonin suppression and significant phase delays (Paul et al. 2007). Some useful lifestyle advice can also be given: ● Take a hot bath 1 hour before going to bed. This

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increases core body temperature, which then starts to drop, simulating the normal temperature drop observed prior to sleep. Limit access to the bedroom and to bed to a very specific time-frame, that is from 1 a.m. to 7 a.m., or from 2 a.m. to 8 a.m. It is very important that the patient avoids falling asleep before this time, for example in front of the television. It is equally important to wake up at the same time every day, even on Sundays, and even when one feels tired and could have slept more. This is an effective method for resetting the inner synchronizers, and most importantly for breaking the mental associations between the bed and the nightly struggle. A siesta, if needed, should not exceed 30 minutes and should occur only in a time slot between 2 p. m. and 5 p. m. Avoid sleeping at other times. Light. Sleeping in very dark rooms is advisable, drawing the curtains to prevent early daylight entering. Also the use of artificial light to simulate natural sunlight or phototherapy devices helps to correct the body’s circadian rhythms. Dietary advice. Avoid coffee (10 hours prior to sleep time) and alcohol (at least 4 hours before sleep). In general, light meals are advisable; give preference to starchy foods over proteins. Carbohydrates stimulate the release of insulin, which leads to a relative increase in Tryptophan levels and helps to increase brain serotonin levels. Snoring and nocturia are two conditions that contribute greatly to insomnia and should be actively treated. Relaxation from tension. Exercise as in yoga is advisable prior to falling asleep. Each part of the body is tensed, the tension is maintained for a few minutes, holding the breath, and then relaxed while breathing out. This helps mobilize the wei qi to move in. Jet lag. For patients who travel regularly, especially when crossing time zones, the internal synchronizers should be reset. Drink but avoid food during the flight, eat only at the appropriate meal time at your place of destination (see also the sections on the prevention and treatment of jet lag in Chapter 4).

Case Studies Insomnia Case 1: Worry and Spleen Qi Vacuity A 19-year-old student who had been preparing for his final exams presented with insomnia that had lasted for a few weeks. He was waking up after a few hours of sleep, worrying and thinking about the exam. He also presented with daytime fatigue and somnolence, as well as reduced concentration and memory, lack of appetite, soft stools, an empty pulse, and a swollen and pale tongue with tooth marks. The sleep analysis suggested a yin qiao disturbance (waking with a clear mind), which was confirmed by the sensitivity of jiao xin KI-8. As the middle phase of sleep was affected, the tai yin channel was involved. The other symptoms pointed to a spleen qi vacuity pattern. For the initial session, I chose zhao hai KI-6 on the side where joia xin KI-8 was most reactive, with lie que LU-7 on the opposite side, as well as bai hui GV-20 and two zu tai yin spleen points: da du SP-2 on the left side to supplement the spleen and calm the shen and the worry, and san yin jiao SP-6 on the right side to regulate qi and blood and help quiet the shen. I saw the patient 3 days later and concentrated on the emotional pattern, namely the worry. As this was a deficient pattern, I used the back shu points: ● Pi shu BL-20 was used to supplement spleen qi and ge shu BL-17 to support the blood. ● Yi she BL-49 was reduced for the worry and obsession. ● Si shen cong (EX-HN-1) was used to calm the mind. I saw the patient 1 week later. His sleep, concentration, and appetite were back to normal. However, he was still worried about his upcoming examination. I supplemented da du SP-2 and shen men HT-7 on the left side, tong li HT-5 on the right, and yin xi HT-6 bilaterally to calm and quiet the shen and overcome his anxiety before having to perform. He passed his exam the following week and got excellent grades.

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Insomnia Case 2: Time Change, Disturbed Synchronizers A 37-year-old man presented with insomnia that had lasted for 2 months, beginning after he had changed job and had to adapt to different working hours. He used to sleep well and for 8 hours. Now he was falling asleep, slept for 4 hours, but then had agitated sleep with physical restlessness, very frequent waking, and mental cogitation. His mind was not clear, and he was tired when he had to get up. He also had two nocturia episodes per night. The man was generally healthy and athletic. He had eczema on his left palm, which had recently become aggravated, and said he had also recently noticed stronger-smelling sweat that was quite rancid. His tongue was slightly pale on the sides, his pulses were slow, the left cun (heart) was tight and the left chi (kidney) was empty. Joia xin KI-8 was reactive on the right side. Analysis. The patient’s sleep was disturbed mainly in the terminal phase, but also partially in the middle phase, as he only slept for 4 out of 8 hours. The mental cogitation and worry are more suggestive of qiao mai (the temporal aspect of sleep) disturbances, the physical restlessness more on the wei mai (the quality of sleep). As the xi point of yin qiao mai was reactive on the right and the condition had clearly started with a shift change (time), I decided to start by regulating the yin qiao synchronizer first and concentrate on the middle phase (tai yin channel) and the terminal phase (jue yin channel): ● Zhao hai KI-6 (on the right) and lie que LU-7 (on the left); LU-7 was added to support tai yin and secondarily as a luo point to release the distal heat (eczema). ● San yin jiao SP-6 was used to support tai yin and supplement liver blood and kidney qi. ● Shen men HT-7 and yin tang (EX-HN-3) were used to calm the mind. ● Shen feng KI-23 on the left was used for mental agitation and excessive thinking. Although, based on the analysis, the jue yin channel should also have been treated, I decided to keep that for the second session. I saw the patient 1 week later. He was sleeping perfectly well, as before the shift change, his energy was back to normal, his body odor was normal again, his eczema had almost disappeared,

and he had only one nocturia episode per night. In the second session, I used: ● Zhao hai KI-6 (on the right) ● Tai chong LR-3 (on the right) with da ling PC-7 (on the left) ● Qu quan LR-8 on the right to further support liver blood ● San yin jiao SP-6 (bilaterally) ● Yin tang (EX-HN-3) I advised the patient to call me back if the insomnia recurred. To date he has not called back, but has instead sent two colleagues with sleep problems to see me. If only all insomnia cases were as simple! Insomnia Case 3: Retained Fear, Shao Yin Pattern A 50-year-old woman had suffered from insomnia for 9 months. She was waking up at around 2 a.m. to 3 a.m., was wide awake and stayed awake for up to 2 hours. When she went back to sleep, her sleep was superficial with dreams that were often fearful. She was tired upon waking. In general, she was a fearful and anxious person. She presented a history of allergies, asthma, and chronic bronchitis. She was still having her periods, which lasted 7 days and were abundant with some clots. A uterine myoma had been diagnosed, she was also overweight and had a tendency to retain water, and she presented some night sweating and one nocturia episode per night. She was constitutionally a water type, with a shao yin personality. Her tongue was slightly swollen and pale with tooth marks. There was a greasy coating on the base with raised red spots; there were also red spots at the tip. Her pulses were generally deep, tight in the left cun (heart) position, slippery on the right guan (spleen), and very deficient in both right and left chi positions (kidney). Analysis. The sleep in the middle and terminal phases was disturbed: ● Her waking in the middle of the night, when she felt wide awake, suggested a “temporal” desynchronization, hence the qiao mai, as the middle phase of her sleep was affected. This is suggestive of a tai yin phase (history of rhinitis, asthma, chronic bronchitis, dampness and phlegm, spleen qi vacuity) disturbance. The pal-

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pation of jiao xin KI-8 revealed sensitivity on both sides. Her superficial and dream-disturbed sleep in the terminal phase suggested a “quality” problem, hence a wei mai disturbance. This was confirmed by the reactivity of zhu bin KI-9. The terminal phase of the night corresponded to shao yin (constitution, water retention, nocturia, fear, pulses).

In the first two sessions, which were 5 days apart, I concentrated on the mid-phase of sleep and the yin qiao mai and the tai yin channel: ● Zhao hai KI-6 and jiao xin KI-8 (on the left) were used as the latter was more sensitive on this side. Lie que LU-7 on the right. LU-7, to open ren mai, was added as the complementary point for yin qiao, and also as a tai yin point. ● Zhong fu LU-1 (bilaterally) was used for waking around 3 a.m. ● San yin jiao SP-6 (bilaterally) was used to regulate qi and blood, to support yin and harmonize tai yin. ● Si shen cong (EX-HN-1) was added in the second session (KI-8 was omitted, and SP-6 needled on the right side only). After the initial sessions, she was still waking because of her nocturia, although going back to sleep much faster; she still had superficial sleep in the terminal phase. The treatment was directed at the wei mai (quality of the sleep) and shao yin (terminal phase of sleep) channels: ● Nei guan PC-6 and zhu bin KI-9 (on the right) were used as the latter was more sensitive on this side. Gong sun SP-4 was added on the left side to open chong mai (uterine myoma) and further support tai yin. ● Fu liu KI-7 (on the right) was used to supplement shao yin and for astringing yin (nocturia), alternating with tai xi KI-3 (to help stabilize the emotions and fearfulness). ● Shen men HT-7 (on the left) was used to calm the shen (pulse) and harmonize shao yin. Later, this was replaced by yin xi HT-6 (for empty heat, night sweating and a red tip of the tongue). ● Yu zhong KI-26 was used to help stabilize shao yin and calm the mind, and alternated with shu fu KI-27 (for persistent insomnia and apprehension).

After three more weekly sessions, the patient was sleeping much better, still waking once to urinate but quickly going back to sleep; her sleep was deeper in the last phase, although still with occasional dreams with fear patterns. She felt much more rested and had more energy during the day. She had no more night sweating and her pulses were better, although the deficiency on the kidney position still remained. The following sessions addressed the root of her emotional problems, the fear stemming from childhood abuse, insecurity, and grief: ● Shen shu BL-23 (supplemented), zhi shi BL-52 (reduced) ● Po hu BL-42 (retained grief) and gao huang shu BL-43 (self-esteem) were sensitive and were reduced, xin shu BL-15 was supplemented. Some follow-up sessions were used to release the consequences of the childhood trauma: ● Shen mai BL-62 (reduced), ku fang ST-14 (reduced), shao hai HT-3 (supplemented); this combination helps release the “undigested” emotions and shocks. ● The above points were alternated with shao hai KI-6 (on the right), lie que (on the left), tai xi KI-3 (on the left), shen men HT-7 (on the right), lian quan CV-23 (knot of shao yin), and zhong zhu KI-15 and yu zhong KI-26, to stabilize the shao yin axis and harmonize the kidney and heart. The patient was treated for a total of 3 months. Her sleep improved and stayed deep. She had no more dreams of fear, felt much stronger and selfassertive, and could speak about her childhood trauma more easily. I advised her to continue with some form of psychotherapy as well as qi gong to help heal the wounds of the past. Insomnia Case 4: Circadian Desynchronization, Shao Yin Pattern A 60-year-old man, a retired pilot, had had a long history of insomnia going back 15 years. He presented with difficulty falling asleep, needing up to 1–1.5 hours to do so. His mind was active and calm at the beginning of his sleep, he read, but after a while he became agitated. He also had superficial sleep and was waking often, with no memory of his dreams. He felt tired in the morn-

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ing. He had a history of stomach ulcers and prostatic hypertrophy, but was otherwise healthy. The tongue was red at the tip, his pulses were strong and slightly tight, and there was deficiency of the left chi (kidney yin). He was constitutionally a fire type, with a tai yang personality, consequently his appearance was hyperactive and restless, with a slightly congested face. Analysis. The initial-stage insomnia with an active mind suggested a qiao mai disturbance involving the shao yin channel. Both jiao xin KI-8 and fu yang BL-59 were reactive. In view of his professional past, the initial treatments aimed at regulating the internal synchronizers: ● Zhao hai KI-6 (on the left) was supplemented, shen mai BL-62 (on the right) reduced, yin tang stimulated, and shen men HT-7 reduced bilaterally. ● The above points were alternated with shao yin harmonization: fu liu KI-7 or tai xi KI-3, shen men HT-7 with shao fu HT-8 (for mental restlessness), zhong zhu KI-15, and yu zhong KI-26. After three sessions, he was able to fall asleep more easily, although there was still some mental agitation and his sleep was still not deep enough: ● An mien (EX-HN-54) and si shen cong (EX-HN-1) were added alternately, as was shen feng KI-23 to help calm the mind. ● Xin shu BL-15 and shen shu BL-23 (supplemented), shen tang BL-44, and zhi shi BL-52 (reduced) were also used. It took several months of treatment to completely normalize the patient’s sleep and calm his mind, as he would periodically lapse back into his habitual mental agitation when stressed. Insomnia Case 5: Blood Xu, Jue Yin Pattern A 45-year-old woman presented with insomnia that had lasted for the past 4 years following the birth of her last child. She had superficial sleep, was waking frequently and easily, was sensitive to noise and had difficulty falling asleep again. She had great difficulty getting going in the morning, and felt tired in general. Apart from this, she had about two stressrelated migraine headaches per month, above the eyebrow (alternating sides) and rather dull in nat-

ure. She had difficulty digesting fats and alcohol, was tired after meals, and had soft stools. She also bruised easily. She had occasional pain in her chest, which was pinching in nature, around the sixth intercostal space on the left side. Her cycles were regular, her period lasting only 1 day, with 2 days of spotting before and 4 days after. In her history, she had had eczema, which had now cleared, and a viral meningitis 6 years previously. Her tongue was peeled, with many cracks in the center and on the sides, and it was also swollen with tooth marks. Although the color of the tongue appeared normal, the inner eyelid was pale. The pulse was empty on the right guan (spleen) position, and thin and deficient on all left positions. Point palpation revealed sensitivity of zhu bin KI-9 and jiao xin KI-8, both on the left. Analysis. The sleep was disturbed in its totality and both synchronizers, yin qiao and yin wei mai, were involved. The pattern points primarily to a substance disharmony, in this case xue blood vacuity of the liver and heart, probably with an underlying liver qi xu (weak liver pulse), a stomach and spleen yin vacuity and spleen qi vacuity. The first three sessions were aimed at supplementing blood by aiding the stomach and spleen, and at calming the shen: ● Zhong wan CV-12, zu san li ST-36, and san yin jiao SP-6 were used. ● These points were alternated with ge shu BL17, gan shu BL-18, pi shu BL-20, shen shu BL-23, xin shu BL-15, and gao huang shu BL-43 (the most reactive points were needled) to support blood production and supplement liver and heart blood. ● Shen men HT-7 was used. ● An mien (EX-HN-54) (for the sensitivity to noise) was used. The quality of the patient’s sleep improved, she had fewer waking episodes, and would go back to sleep more quickly, but she was still very sensitive to noise. The following sessions aimed at regulating the yin wei mai and calming the shen: ● Nei guan PC-6 (on the left), zhu bin KI-9 (on the left), and gong sun SP-4 (on the right) were used. In this case, gong sun SP-4 was added to support yin wei and to help uphold the spleen qi (spotting, easy bruising, soft stools). ● Fu she SP-13, da heng SP-15, and fu ai SP-16 were palpated and the reactive points needled.

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This is the tai yin segment of yin wei mai (stinging pain in the chest). These points of both groups above were alternated with tai chong LR-3 and qu quan LR-8 (to supplement liver blood) together with da ling PC-7 (to quiet the shen) and jian shi PC-5 (to calm the shen and help move yin up to the head).

The stomach yin had to be supported regularly with: ● Zhong wan CV-12, zu san li ST-36, chong yang ST-42, yang chi TB-4, and san yin jiao SP-6 The treatment took almost 6 months, with sessions first weekly and then every other week, before sleep normalized and before the tongue coating returned and the patient’s overall energy levels improved. Insomnia Case 6: Somnambulism, Tai Yin Pattern A 40-year-old man presented with insomnia that had lasted for over 10 years. His sleep was superficial, with easy waking, and occasional difficulty falling asleep through worry. There were also occasional episodes of nightmares, sleep-walking, or sleep-talking, which were aggravated by overwork or stress. He felt tired in the morning and during the day. He had a pale and dull complexion, was healthy overall, and only had some bloating and tiredness after meals and a tendency to soft stools. His tongue was swollen with tooth marks and a greasy coating. The pulses were of a weak and deficient quality overall. He had an earth–metaltype constitution and a tai yin metal temperament. Zhu bin KI-9 appeared more reactive, although not very clearly. Analysis. The patient’s sleep was disturbed in its quality (superficial), indicating a yin wei pattern; occasional initial phase difficulty suggested the tai yin level was affected, which is consistent with the spleen qi vacuity symptoms and the worry. In my experience, sleep-walking and nightmares are usually seen in repletion patterns, especially in men. In this case, however, there was no evidence of an excess-type pattern. The dampness and phlegm were not affecting the upper functions (the patient had an excellent intellect and memory). The strategy therefore aimed at supplement-

ing spleen qi to produce blood and help settle and calm the shen. The points were mainly chosen from the tai yin and yang ming channels: ● Nei guan PC-6 (on the left) and gong sun SP-4 (on the right) were used. ● San yin jiao SP-6 (bilaterally) and zu san li ST36 (bilaterally) were used to support spleen qi and blood production. ● Shen men HT-7 was used bilaterally. ● Yin tang (to calm the mind) was alternated with an mien I (EX-HN-52) or an mien II (EX-HN-53) (sleep-walking). ● All the points above were alternated with yin bai SP-1 and li dui ST-45, both for restless sleep and nightmares, and da ju ST-27 (for insomnia from worry). An important part of the treatment was to settle the shen and the hun and stop the worrying: ● Xin shu BL-15, gan shu BL-18, and pi shu BL-20 were supplemented. ● Shen tang BL-44, hun men BL-47, and yi she BL-49 were reduced. After six weekly sessions, the patient’s sleep was much deeper, there had been no episodes of sleepwalking or nightmares, and his overall energy was much improved. I saw him occasionally during periods of stress over the coming years. One or two sessions were usually enough to re-establish equilibrium. Insomnia Case 7: Nightmares, Jue Yin Pattern A 31-year-old woman had suffered from insomnia for 6 years following the birth of her child. Her sleep was agitated, with frequent waking, occasional nightmares (worse in the premenstrual phase), restless legs and paresthesia (pins and needles) in the extremities, and occasionally difficulty falling asleep. She was very tired in the mornings and had difficulty starting the day. Her cycle was regular with strong premenstrual cramps and breast tension. She was also intolerant to fats, suffered from neck tension, and had constipation with goat pellets. In her history, there was cystitis in her teens, anxiety attacks at 15 (later diagnosed as spasmophilia), and ovarian cysts that had been operated on at 16. Her tongue was red on the sides, with red spots at the tip and a thick

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and greasy coating at the root with red and raised spots. The pulse was strong and wiry on the left guan superficial (gallbladder) and hollow in the deep (liver) positions, slippery on the right guan (spleen), and quite weak in the left chi (kidney yin) positions. Both zhu bin KI-9 and jiao xin KI-8 were reactive. She appeared to be constitutionally a wood type with a jue yin personality. Analysis. The sleep was disturbed in its quality (restlessness and nightmares), as well as in its length, with initial stage insomnia. The patient’s constitution and history suggested a jue yin pattern, with strong liver qi stasis, aggravated by liver blood vacuity and kidney yin vacuity following childbirth. The liver yang rising accounted for the nightmares. As she was in the last part of her cycle, the first treatment focused on moving liver qi: ● Tai chong LR-3 (on the right) and da ling PC-7 (on the left) were used to harmonize the liver. ● Xing jian LR-2 (on the left) and qu quan LR-8 (on the right) were used to reduce liver heat and supplement liver blood. ● Ben shen GB-13 with shen ting GV-24 were used to settle the mind (nightmares). ● Zhao hai KI-6 (on the right; where KI-8 was most reactive) was added to help harmonize the cycle and the premenstrual breast distension. I saw the patient a week later. She had slept very well and had had very few premenstrual complaints. In the following session, as it was the ascending phase of yin, I concentrated on the shao yin, to stabilize the yin and the liver yin and blood: ● Zhao hai KI-6 and jiao xin KI-8 (on the right), and shao fu HT-8 (on the left), were used, as were tai xi KI-3 (on the left) and shen men HT-7 (on the right). ● Zhong zhu KI-15 and yu zhong KI-26 were used to close the shao yin inward. This is an excellent strategy for stabilizing an unstable jue yin (spasmophilia). In a follow-up session, the back shu points and the shen and hun were treated with xin shu BL-15, shen tang BL-44, gan shu BL-18 and hun men BL-47. The patient was seen a few more times over the coming months. Her sleep continued to be good, with no nightmares. The restless legs syndrome (RLS) recurred once, and was treated with qu quan LR-8, yang ling quan GB-34, and yang jiao GB-35.

Insomnia Case 8: Liver Qi and Blood Vacuity, Heart Blood Vacuity A 32-year-old man had suffered from insomnia for 6 months, and it had been getting progressively worse. He was waking up between 2 a.m. and 4 a.m., and then either had restless and superficial sleep, often waking with palpitations, or simply could not go back to sleep, with mental agitation. His sleep was much better on the weekend. He was starting to feel exhausted, but otherwise was in good health. He had difficulty digesting fats and alcohol, and had constipation, with goat pellet stools. His tongue was peeled in patches and red. His pulses were slightly rapid and deficient in the left deep positions. Zhu bin KI-9 and jiao xin KI-8 were reactive on the left, as was fu yang BL59 on the right. Analysis. Waking early with a clear mind suggests a temporal disturbance, namely of the qiao mai, and the terminal phase of the night is suggestive of a disturbance of the jue yin channel. The restlessness or superficial sleep of the middle and terminal phases suggests a disturbance of the quality (depth) of sleep, concerns the wei mai and is suggestive of a disturbance of the jue yin or shao yin segments. As the sleep seems more disturbed in its quality rather than in quantity, with obvious liver qi and blood patterns, the initial treatments aim at synchronizing the wei mai. The following points were used: ● Nei guan PC-6 (on the left) and gong sun SP-4 (on the right) ● Tai chong LR-3 (on the right) (for restlessness), qu quan LR-8 (on the right) (for restlessness), and da ling PC-7 (on the left) ● Yu tang CV-18 (knot of jue yin, for anxiety and palpitations) ● Ting hui GB-2 (insomnia after 3 a.m.), alternating with wan gu GB-12 After two sessions, 1 week apart, the patient’s sleep had improved, he was waking up less frequently and had fewer palpitations, but he was still waking early with a clear mind, although no agitation. The following points were used: ● Zhao hai KI-6 (on the left), shen men HT-7 (on the right), and shen mai BL-62 (reduced on the right) ● Shen cang KI-25 (for a restless mind) and shu fu KI-27

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San yin jiao SP-6 Yin tang, alternating with si shen cong (EX-HN1) All the previous points were alternated with back shu points: xin shu BL-15, gan shu BL-18, shen shu BL-23, shen tang BL-44, and hun men BL-47 (the most reactive points being needled).

In the follow-up sessions, the stomach yin was supplemented as well with: ● Zhong wan CV-12, zu san li ST-36, chong yang ST-42, and yang chi TB-4, with the addition of shan ju shu ST-37 and xia ju shu ST-39 to help with the production of fluids and the lubrication of the intestines (the points ST-36, ST-37, and ST-39 were palpated and needled on the more reactive side). The patient was followed for a total of 10 sessions over 5 months. His sleep was satisfactory, with no more palpitations, and his bowel movements became regular providing he did not indulge in greasy and fried foods or alcohol. He was still prone to stress, which disrupted his sleep, but only for a night or two. Insomnia Case 9: Spleen Qi Vacuity with Dampness A 44-year-old man had suffered from insomnia for over 6 months. He claimed that he had not slept at all for the past 2 months. His sleep was analyzed for two nights in a sleep laboratory, which showed that he actually did sleep for 4–5 hours, but quite superficially, waking frequently. He was slightly overweight, complained of bloating and tiredness after eating, and had soft stools, spontaneous sweating, and two nocturia episodes per night. His tongue was swollen with a greasy coating. His pulses were weak and empty on both guan (spleen and liver) positions, as well as the left chi (kidney) position. The xi points were not reactive. Analysis. This is obviously a disturbance of the quality (depth) of sleep, even though the wei mai does not seem to be affected. The spleen qi vacuity is the main pattern. The treatment aims at supplementing: spleen qi, and heart qi and blood, and liver blood and kidney qi. The treatment involved: ● San yin jiao SP-6 ● Shen men HT-7 ● Yin tang, alternated with si shen cong (EX-HN-1)

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All of the above points were alternated with the following points: – Pi shu BL-20, xin shu BL-15, and gan shu BL18 (for superficial sleep) – Shen shu BL-23 and fu liu KI-7

After four sessions, the patient seemed to be sleeping better, although the tiredness and the spleen patterns were still present: ● Zhong wan CV-12, san yin jiao SP-6, da du SP-2, gong sun SP-4, and zu san li ST-36 were alternated with the following; Fu liu KI-7, zhu bin KI-9, and shu fu KI-27. The treatment continued for a total of 10 sessions. The patient’s sleep and other symptoms improved only partially. Insomnia Case 10: Liver Blood Vacuity A 47-year-old woman had suffered from insomnia for 1 year, with frequent waking, restless sleep, jerking during the night, periods of staying awake with mental agitation, worry, and obsessive thinking; she was very tired upon waking. She also complained of premenstrual migraine headaches, episodes of dizziness, blurred vision, and reduced night vision, a tendency to palpitations, muscle cramps, and some paresthesia of the extremities. Recently, she had also had night sweating and loss of hair. Her tongue was pale and dry with a peeled coating and cracks in the center, and some red spots on the sides. The pulses were weak and thin in all of the deep positions, especially on the left side. Zhu bin KI-9 was most reactive on both sides. Analysis. A typical liver blood vacuity pattern affecting the sinews, but also a heart blood vacuity pattern with mental agitation. The patient’s age and the recent night sweating were suggestive of a declining kidney yin. I mostly selected jue yin and shao yang points for this patient: ● Nei guan PC-6 (on the right) and gong sun SP-4 (on the left) ● Tai chong LR-3 (on the right), qu quan LR-8 (on the right) (to supplement liver blood), together with da ling PC-7 (on the left) (to quiet the shen) ● San yin jiao SP-6 to support blood and yin ● Wan gu GB-12 (shao yang point to help relax the mind and body), or yi ming (EX-HN-54).

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● ●

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Si zhu kong TB-23 (for the jerking at night) All of the above points were alternated with ge shu BL-17, gan shu BL-18, pi shu BL-20, shen shu BL-23, xin shu BL-15, and gao huang shu BL-43 (the most reactive points being needled) to support blood production and supplement liver and heart blood; yi she BL-49 was used for worry. Additionally: da du SP-2 or shang qiu SP-5 was used for obsessive thinking.

The patient was treated for a total of seven sessions over 2 months. Her sleep improved greatly and became deeper; she had no more palpitations or headaches. However, her pulses remained weak and the tongue still pale. She was given dietary advice and herbal supplements for the blood. Insomnia Case 11: Nightmares, Liver Fire A 30-year-old woman consulted me for intense premenstrual syndrome with lower abdominal pain and cramps, breast distension and pain, strong migraine headaches in the temporoparietal region, mostly on the left side, irritability and moodiness for a week before her periods. Her period lasted for 5 days with abundant and scarletcolored blood. Her sleep was generally bad, with many nightmares, with themes of aggression, and she woke up frequently, often with palpitations. However, her sleep got even worse during the premenstrual phase. She showed a tendency to constipation with dry stools or goat pellets and frequent genital herpes. She had a propensity to be impatient, accompanied by bursts of anger. Her tongue was red with redder sides, and her pulses were wiry and rapid in general. She was a wood type with a jue yin personality. Palpation revealed strong reactivity of tai chong LR-3 and qi men LR-14. Analysis. All the elements point to an exuberant liver yang from liver qi stasis. In regard to the amount of liver heat, I inquired about lifestyle and diet. She liked to stay up late, had dinner quite late when her husband came home, and mostly ate red meat and drank wine at night. ● Tai chong LR-3 (on the right), da ling PC-7 (on the left), and qi men LR-14 (on the right) were used to harmonize the liver. ● Xing jian LR-2 (on the left) and lao gong PC-8 (on the right) were used to reduce liver heat.

● ● ●

Yu tang CV-18, knot of jue yin (for palpitations) Ben shen GB-13 with shen ting GV-24 were used to settle the mind (nightmares). The patient was advised not to eat red meat.

I saw her a week later: she had had no nightmares, and her sleep was less agitated. After this, she was treated twice per month in mid-cycle and in the premenstrual phase. After 3 months, she was having deep and peaceful sleep, with no more premenstrual headaches, and was much less tense. She was also advised to exercise regularly. Insomnia Case 12: Sleep-walking, Stomach Fire An 8-year-old boy had been diagnosed with attention deficit disorder and hyperactivity. He had a strong constitution, was quite restless, and had a clammy body. He had a tendency to catch colds easily and had had many courses of antibiotics, especially in his earlier years. He had restless sleep with episodes of sleep-walking and sleep-talking. He was quite tired in the mornings, with halitosis, had little appetite, was constipated with frequent belly aches, and sweated easily. His tongue had a yellow coating, with reddish spots along the surface. Analysis. There was an obvious stomach heat pattern (restless sleep, halitosis, no appetite in the morning, constipation), with an underlying qi deficiency (spontaneous sweating, a propensity to catch colds). There was most probably residual heat (tongue spots) in the yang ming. The following points were stimulated with an infrared (670 nm) 40 mW laser for 10 seconds each: ● In the first two sessions tian shu ST-25, zu san li ST-36, shang ju xu ST-37, xia ju shu ST-39, and zhi gou TB-6 to clear heat from the yang ming ● In the third session yin bai SP-1, li dui ST-45, shen men HT-7 and an mien (EX-HN-54) to calm the mind and settle the shen ● The following sessions aimed at harmonizing the center using zhong wan CV-12, jian li CV11, and xia wan CV-10, with zu san li ST-36, da du SP-2, and tai bai SP-3. ● All of the above points were alternated with zhong wan CV-12 with zu san li ST-36, followed by shang wan CV-13 with nei guan PC-6, followed by xia wan CV-10 and tian shu ST-25, followed by qi hai CV-6 to strengthen the center and the production of post-heaven qi.

Case Studies

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The boy’s mother was instructed to moxa zu san li ST-36 for 7 days around the new moon every month to build up the ying qi and wei qi.

The patient’s sleeping problem resolved rapidly, and the stomach heat subsided after the first month. I saw the child a few months later; he had not been sick and seemed more calm and attentive, he had regular bowel movements, and his appetite was good. Insomnia Case 13: Waking Early, Insomnia A 50-year-old woman, premenopausal, complained of recent terminal-stage insomnia: she was waking up too early, often in a bad mood, feeling tired but unable to go back to sleep. She occasionally also had hot flashes and sweating when she woke in the morning. Her tongue had a reddish tip. Her pulses were rapid, slightly thin, and weak in the left guan and chi (liver and kidney) positions. All the xi points of the four extraordinary vessels were reactive, as were most of the points around her ankles. Analysis. The quality of the sleep (wei mai) was disturbed; the terminal phase corresponds to the shao yin channel. The following points were used: ● Zhu bin KI-9 (bilaterally; starting point of yin wei and shao yin point), fu liu KI-7 (on the right), yin xi HT-6 (on the left; for night sweating), shen men HT-7 (on the right; to calm shen), and yu zhong KI-26 (for waking in a bad mood) Two sessions were sufficient to normalize the patient’s sleep. She was seen 6 months later to further treat her recurring menopausal symptoms, but her sleep remained satisfactory. Insomnia Case 14: Enuresis, Night Frights, and Insomnia A 10-year-old boy had been bed-wetting due to very deep sleep. His parents had tried everything; the mother had to resort to a “bed-wetting alarm,” which often woke her up at least twice a night but not the child. In his history, he and his twin sister had been born prematurely. His parents had recently separated. He had allergic asthma triggered by animal hair, but was otherwise healthy and not prone to colds, and he had no digestive

problems. The boy showed difficulty falling asleep, taking between 30 and 60 minutes to do so. His mind was quiet and clear, but then his sleep was very deep and often his mother had difficulty waking him up in the middle or at the end of the night. He also presented with night terrors, or fearful dreams, always before midnight and often not remembering the topic of the dream. He was often tired in the mornings. His tongue was normal and his pulses tight on the left middle guan (liver) and knotted on the left chi (kidney) positions. He had quite dark circles under his eyes, appeared quite sharp and present, and seemed not to be fearful. His mother even said that he had a daring and risk-taking character. Analysis. The difficult and premature birth could suggest a kidney jing weakness, although there was no evidence of growth or mental retardation. A kidney qi or yang or jing vacuity might explain the enuresis. The yang vacuity was also consistent with the very deep sleep, and a kidney jing weakness (knotted pulse) may have derived from liver blood vacuity causing the nightmares and the night terrors. In the absence of other clinical symptoms, I selected this last hypothesis. The boy’s daring nature defied the kidney deficient pattern, but could have been a contraphobic attitude. The initial stage insomnia would also fit the shao yin pattern (yin qiao mai). ● In the first session, I used shen shu BL-23, zhi shi BL-52 (reduced to release fear and excessive willpower), fu liu KI-7 (on the left; for astringing the urine), shen men HT-7 (on the right), and bai hui GV-20. ● During the following week, there were fewer nightmares and no enuresis but still one episode of nocturia: gong sun SP-4 (on the left; chong mai was treated to address the birth trauma and help uphold the spleen qi), tai chong LR-3 (on the right), qu quan LR-8 (on the right; for liver blood), bai hui GV-20, and jian shi PC-5 (on the left; for night terrors). ● His sleep became less heavy, although he still had an occasional single episode of nocturia, and he was still taking 30 minutes to get to sleep. The following points were used: fu liu KI-7 (on the left), zhao hai KI-6 (on the right), shen men HT-7, guan yuan CV-4 (to support the kidney and for night terrors), si shen cong (EXHN-1), KI-1 (with the laser, to settle the shen and help with night frights).

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The boy was later seen twice in 2-week intervals. The enuresis and night frights had stopped, his sleep was lighter, and he was waking up rested. Insomnia Case 15: Nightmares, Sleep-walking, Sleep-talking An 11-year-old girl had had episodes of nightmares, somnambulism, and night-talking. She was falling asleep very rapidly, had agitated sleep with night sweating, especially of her hands, and was waking up in a bad mood. She was very anxious and insecure, and did not like to be touched. She showed thoracic, throat, and epigastric tightness. The girl had a tendency to muscle cramps, and was in general quite stiff. She had been born prematurely with neonatal jaundice, but there were otherwise no other health issues in her history. Her tongue was peeled at the front with many red spots, and a thin coating at the base. Her pulses were weak and thin in the left cun and chi (heart and kidney) positions and tight in the guan (liver) position. Analysis. Heart heat (fire) from heart yin vacuity could have been causing the restlessness, agitation, and nightmares with sleep-walking and sleep-talking. This was consistent with the findings in the tongue and pulses, although the girl was falling asleep rapidly. The root of this could be the kidney yin vacuity (pulse and tongue). However, liver blood vacuity with qi stasis could also have been causing the nightmares and agitation, and was consistent with her history and the other symptoms. ● In the first session, I used tai chong LR-3 (on the right), qu quan LR-8 (on the right), san yin jiao SP-6 (liver blood), qi men LR-14 (on the right; to move liver qi); an mien (EX-HN-54) (for sleepwalking), ben shen GB-13, and shen ting GV-24 (for nightmares). ● In the second session, I used gan shu BL-18, pi shu BL-20, ge shu BL-17, shen shu BL-23, and hun men BL-47, as well as an mien (EX-HN-54). The girl had no more nightmares and did not sleep-walk, but she still talked in her sleep. The following points were used: ● Zhu bin KI-9 (on the right), tai xi KI-3 (on the right), shen men HT-7, and yu zhong KI-26 (for waking in a bad mood) After this, there was no more sleep-talking. A final treatment addressed her birth trauma:

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Gong sun SP-4 (on the right); nei guan PC-6 (on the left): here chong mai is used to harmonize blood and qi and to release perinatal issues; yin wei to move liver and chest qi, and to improve the quality of sleep, tai chong LR-3 (on the left); yu tang CV-18 (knot of jue yin, for chest oppression), and ku fang ST-14 (not liking to be touched).

Insomnia Case 16: Snoring, Sleep Apnea A 70-year-old patient had been diagnosed with obstructive sleep apnea (OSA) and instructed to use a continuous positive airway pressure (CPAP) device during the night. He had a history of snoring with frequent waking, needing 8–9 hours of sleep, and felt tired in the morning. His sleep and daytime tiredness had greatly improved since he had been using the CPAP device. He had a tendency to catch colds easily, which sometimes evolved into bronchitis, and he had smoked up until 10 years previously. Otherwise, he was healthy, with a tendency to some bloating and tiredness after meals. His bowels were regular. His tongue was large with a slightly sticky coating. His pulses were strong and slippery in the right guan (spleen) position. Constitutionally, he was metal and earth, with a yang ming temperament. Analysis. The OSA suggested that the wei qi was having difficulty returning inward. The obstruction at the nose or the throat would also have been causing the snoring, and obstruction at the chest could have been causing the apnea. Phlegm, the most common cause of sleep apnea, was not really present; the patient was not overweight and did not have other phlegm symptoms. Therefore, I chose to work on the obstruction at different levels: ● For the nasal obstruction: shen mai BL-62 (reduced), yin tang (EX-HN-3), ying xiang LI-20, and pian li LI-6 (luo connecting point affecting the nose, throat, and chest) ● For the throat obstruction: tian ding LI-17, lian chuan CV-23, que pen ST-12, and zhong fu LU-1. These points were alternated with: fu tu LI-18 and yun men LU-2 (both to regulate the movements of wei qi and ying qi). ● For the chest obstruction: ge shu BL-17 and gao huang shu BL-43, zong hui TB-7; jian shi PC-5

Case Studies

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(also to clear phlegm from the throat), yin bai SP-1 (for chest oppression), and shan zhong CV17. In all cases, nei guan PC-6 was regularly treated to open yin wei mai to help the quality of sleep and as a luo to open the chest. Occasionally, this was combined with gong sun SP-4 and other local chest points such as bu lang KI-22 (chong mai confluent point to support the lung), yu zhong KI-26 with zhong zhu KI-15 to help the inward movement of the yin, and to help qi return to the kidney. These points were alternated with qi xue KI-13 and qu gu CV-2 (to fortify the kidney and help reception of lung qi). Other tai yin points were regularly treated, including yin bai SP-1, da du SP-2, shang qiu SP-5 (for dampness); zhong fu LU-1, yun men LU-2, lie que LU-7 (to rectify lung qi), and feng long ST-40 (to resolve dampness in the chest). Once in a while the back shu points were used: fei shu BL-13, pi shu BL-20, shen shu BL-23, ge shu BL-17, gao huang shu BL-43, and shen zhu GV-12 (to support lung qi).

Overall, I saw the patient over a period of 6 months, first on a weekly basis and later twice a month. He was able to sleep most nights without using his CPAP device, although he still used the device when he had had a heavier meal or when he was traveling and staying in hotels. Insomnia Case 17: Sleep Apnea, Snoring A 60-year-old patient had had a long history of very heavy snoring after an episode of laryngitis some 30 years ago. He had been frequently and suddenly waking in a state of panic during the night. His wife had noticed a strange breathing pattern, which after analysis was diagnosed as OSA. He was given a CPAP device to use. After a few months of trying the device, he found it very awkward and handicapping. In his history, there were many episodes of upper respiratory and lung infections. In general, he was in delicate health, slightly overweight, with a history of recurring lumbar pains and two episodes of nocturia per night. He often had a puffy face upon waking. The patient looked much older than his age, and complained of frequent anxiety and fear, with frequent panic attacks. The tongue was swollen and slightly

bluish, with a greasy coating at the base. His pulses were rather slow and deep, being very weak in both chi (kidney) positions. He had a water type constitution with a shao yin temperament. Analysis. The local obstruction of the patient’s throat and chest appear to have been aggravated by the accumulation of damp phlegm in the chest. I considered the root cause to be kidney vacuity, especially of kidney yang, with deficiency of the digestive fire and accumulation of phlegm. The kidneys were also not able to receive and hold lung qi. The panic attacks and anxiety indicated the use of chong mai and yin wei, with the emphasis on the shao yin. ● In the first session, I used nei guan PC-6 (on the left) coupled with gong sun SP-4 (on the right), zhu bin KI-9; lian chuan CV-23 (knot of shao yin), fu liu KI-7 (on the left), and shen men HT-7 (on the right). ● In the second session, I used gong sun SP-4 (on the left), nei guan PC-6 (on the right); tai chong LR-3 (on the right), jian shi PC-5 (on the left), shan zhong CV-17, and shen cang KI-23. ● In the following session, I employed fei shu BL13, pi shu BL-20, shen shu BL-23, ge shu BL-17, gao huang shu BL-43, zhi shi BL-52, and ming men GV-4 (the most reactive points being needled). ● The treatments alternated between opening the chest, supporting the kidney yang and qi and the spleen. The patient was also instructed in better sleep hygiene. His diet was modified to reduce food overload at night, to reduce damp- and phlegm-producing foods, and to avoid alcohol, especially in the evening. After 3 months of treatment, the patient’s overall health had greatly improved. He had no more panic attacks, was less anxious in general, and only had one nocturia episode per night. He was able to do without the CPAP device most of the time. However, his snoring remained unchanged. Insomnia Case 18: Night Terrors A 4-year-old child had been having night terrors for 6 months, involving up to 15 episodes of waking up crying during the night. It turned out that the terrors started shortly after he had witnessed an intense argument between his mother and her

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parents. He was otherwise healthy, and had an average appetite and regular bowel movements. He sweated during the night, and had recently been rather listless. Analysis. The usual patterns that cause night terrors or nightmares appeared to be absent. The emotional impact of seeing his mother and grandparents fighting had been a strong enough shock to cause this deep insecurity. The treatment was aimed at releasing this emotional shock. During the first session, I used ku fang ST-14, shao hai HT-3 (on the left), shen men HT-7 (on the right), shen mai BL-62 (on the left), and jian shi PC-5. The seven points were stimulated with a 40mW infrared laser for 10 seconds each. The boy was seen a week later. He had had only two episodes of night terror during the whole week. Treatment of ku fang ST-14, shao hai HT-3, shen men HT-7, and jian shi PC-5 was repeated one more time. The mother was instructed to call back a week later to report on his sleep. He had no more night terrors or nightmares after that. Insomnia Case 19: Insomnia from Fear, Shao Yin A 10-year-old girl had been having difficulty falling asleep since her infancy. She would be wide awake and take up to 1–1.5 hours to fall asleep. There was no physical restlessness, she often read to fall asleep, and she disliked the dark, and had to have a small light on in her room. She had one nocturia episode per night, hot extremities, and was generally nervous, quite anxious, and fearful. She tended to be tired, but otherwise had no other revealing symptoms. Her tongue was reddish at the tip. In her history, her birth had been difficult during which she almost died. Most pertinent of all, when she was 10 months old, her mother’s sister had lost her child to sudden infant death syndrome (SIDS), which had, of course, totally shocked the whole family. The girl’s mother started dropping

in on her child regularly and all through the night, at which time the girl’s insomnia began. Analysis. The girl’s sleep was very obviously disturbed in its temporal aspect (yin qiao mai) and in the initial phase; which is suggestive of a disturbance of the shao yin channel. Although there were not many symptoms to go by, there were, however, a few indications of a kidney qi or particularly yin vacuity, with some heart heat. The difficult birth affected the chong mai and the kidneys. The emotional shock, although she was only an infant, had obviously had a great impact on her. ● The initial treatment aimed at regulating the yin qiao by supplementing zhao hai KI-6 (on the right), and reducing shen mai BL-62 (on the left); yin tang was stimulated, shen men HT-7 (on the left) reduced, and fu liu KI-7 (on the right) supplemented. ● At this point, the girl began to fall asleep more easily and had no more episodes of nocturia. The follow-up sessions aimed at releasing the shock and supporting chong mai and the kidneys using: – Shen mai BL-62, xiao hai HT-3, and ku fang ST-14 (to release the shock pattern) – Gong sun SP-4 (on the right), nei guan PC-6, shen feng KI-23, and shen cang KI-25 (for insomnia and anxiety), with bai hui GV-20 – Xin shu BL-15 and shen shu BL-23 were both supplemented, zhi shi BL-52 was reduced, shen tang BL-44 stimulated. The patient was seen five times, on a weekly basis, and her sleep became normal. Over the next 2 years, she was seen several times when this pattern recurred whenever she experienced stress or a change in her life. Usually, one or two sessions were sufficient to regulate her sleep, although she still easily became anxious. More consistent treatment of the shao yin axis and the kidneys was felt to be advisable.

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Other Sleep Pathologies

Somnolence—Shi Shui 嗜睡 Explanation and Discussion Somnolence, defined as a predilection for sleep, varies from mild drowsiness or a desire to sleep, to a condition known as narcolepsy, in which the individual constantly falls asleep. This condition may or may not be associated with difficulty sleeping at nighttime or with conditions in which sleep is not deep enough. In general, somnolence is due to an accumulation of yin in the upper body and in the head. The yin repletion is most often the result of an accumulation of dampness in the upper body parts, which prevents the rising of the clear yang of the stomach. This pattern involves the organs that process fluids and may produce dampness: the lung, spleen, and kidney (specific points such as chi ze LU-5, shang qiu SP-5, and da chong KI-4), and the triple burner (san jiao) system in general. Specifically, as arm yang channels distribute fluids to the orifices and help open them, points such as san yang luo TB-8 (Meeting of the Three Yang) or tian jing TB-10 are indicated. Er jian LI-2 and san jian LI-3 are also traditionally indicated for somnolence. The yin repletion could either be due to a repletion in the yin qiao mai (yin motility vessel) with its symptom described as “the eyes cannot open, somnolence,” or due to vacuity in the yang qiao mai, with the symptom of “daytime lassitude and sleepiness” (Ling Shu, Chapter 21). As was explored in Chapter 3, palpation of the respective xi (cleft) points (jiao xin KI-8 and fu yang BL-59) helps to differentiate which channel is involved. Yin accumulation may also result from blood stasis, mainly involving the liver. This blood stasis could be a consequence of the sequelae of internal wind, causing a cerebrovascular accident, but can also be post-traumatic, occurring after concussion or very frequently following whiplash injuries. Some severe feverish diseases, such as meningitis or Lyme disease, can also produce similar conditions in which local stasis of phlegm or blood prevents the clear yang from ascending to the head.

The inability of yang to ascend is not only due to an accumulation of yin in the upper body, phlegm obstruction, or blood stasis, but can also be the consequence of yang deficiency, as in kidney yang vacuity patterns. In practice, I have very often noticed a combination of factors, for example a kidney and spleen yang vacuity, in which the ascent of yang to the head is further hampered by phlegm blocking the orifices. With reference to the combination of factors mentioned above, it is also interesting to consider the jing bie (divergent channels) and the Window of the Sky points, in particular: ● Jing bie of the stomach and spleen (qi chong ST-30 and chong men SP-12), whose function is to carry clear yang and fluids to the head (especially the eyes). The points are used together with ren ying ST-9, as a Window of the Sky point, which brings yang to the head with the help of bai hui GV-20 via jing ming BL-1. ● Jing bie of the lung and large intestine (jian yu LI-15 and zhong fu LU-1) with tian ding LI-17, which brings yang to the head, and fu tu LI-18, which helps bring wei qi (defensive qi) to the surface ● There are also two Window of the Sky (or Window of Heaven) points that regulate the movements of blood and qi to and from the head: – Tian fu LU-3, for forgetfulness and cerebral congestion – Tian chi PC-1, for headaches, blurred vision, and psychotic episodes ● Some classical point indications for sleepiness are: – Er jian LI-2: tendency to fall asleep – Li dui ST-45: excessive dreaming or sleepiness – Jing ming BL-1: insomnia or sleepiness (regulates the qiao mai) – Shen mai BL-62: somnolence (should be supplemented) – Ri yue GB-24: somnolence – San jian LI-3: likes to lie down – Shou wu li LI-13: likes to lie down

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Patterns and Treatment Phlegm Misting the Mind Symptoms ● Sleepiness after meals, the head feels muzzy ● Dizziness ● Feeling of heaviness; chest oppression ● Blurred vision ● Copious sputum; nausea ● Snoring (sleep apnea is quite common in these cases) ● Tongue: swollen with a sticky coating ● Pulse: slippery Treatment Resolve phlegm, supplement the stomach and spleen, and open the orifices: zhong wan CV-12, pi shu BL-20, san jiao shu BL-22, zu san li ST-36, feng long ST-40, tou wei ST-8, san yin jiao SP-6, shui fen CV-9; san yang luo TB-8 (helps open the orifices), tian jing TB-10, chi ze LU-5, shang qiu SP-5 (for those who need to sleep all the time), da chong KI-4 (for those who can sleep anytime), zhao hai KI-6 (yin qiao mai). Blood Stasis in the Upper Body, with Possible Underlying Blood Vacuity Symptoms Sleepiness, lack of concentration, loss of memory ● Often following a stroke episode or a trauma (whiplash) ● May be associated with agitated nighttime sleep ● Abdominal masses, painful periods ● Headaches, chest pain (angina) ● Tongue: purple, or purple spots ● Pulse: wiry or choppy ●

Treatment Regulate blood and move liver qi: ge shu BL-17, yin lian LR-11, da dun LR-1 (moxa), tai chong LR-3, he gu LI-4, gan shu BL-18, gao huang shu BL-43, xue hai SP-10, bai hui GV-20, tian chi PC-1, tian fu LU-3.

Spleen Qi Vacuity Symptoms ● Sleepiness; mental and physical asthenia ● Often following a stroke episode ● Heaviness of the limbs ● Lack of appetite, bloating, soft stools ● Spontaneous sweating ● Dull or pale complexion ● Tongue: swollen with tooth marks, white sticky coating ● Pulse: weak or empty Treatment Supplement the spleen and stomach, and supplement qi: zhong wan CV-12, pi shu BL-20, san jiao shu BL-22, zu san li ST-36, tou wei ST-8, bai hui GV-20, tai bai SP-3, shang qiu SP-5, san yang luo TB-8, er jian LI-2, san jian LI-3; also li dui ST-4 with yin bai SP-1 or da du SP-2. Heart and Spleen Qi Vacuity Symptoms ● Sleepiness, fatigue, weakness ● Palpitations, shortness of breath ● Lack of appetite, bloating, soft stools ● Forgetfulness ● Dull or pale complexion ● Tongue: swollen, pale with tooth marks, thin white coating ● Pulse: weak or fine Treatment Supplement the spleen and heart qi: zhong wan CV-12, pi shu BL-20, san jiao shu BL-22, xin shu BL-15, zu san li ST-36, san yin jiao SP-6, bai hui GV-20, xin hui GV-22, shen mai BL-62, er jian LI-2, san jian LI-3; also li dui ST-45 with da du SP-2. Kidney Yang Vacuity Symptoms ● Sleepiness, apathy, mental fatigue ● Maybe episodes of sleep-walking; exhaustion upon waking ● Forgetfulness ● Lack of willpower, depression ● Dislike of cold ● Lumbar pains, worse with cold ● Tinnitus

Somnambulism/Sleep-walking—Meng You 梦游

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Frequent urination, edema Tongue: swollen, pale or bluish Pulse: weak and slow

Treatment Warm yang, supplement qi, supplement kidney yang, and support the ascent of yang: shen shu BL-23, zhi shi BL-52, pi shu BL-20, ming men GV-4, tai xi KI-3, feng fu GV-16, bai hui GV-20, xin hui GV-22, shen mai BL-62, ju gu LI-16, er jian LI-2, san jian LI-3.

Somnambulism/Sleep-walking— Meng You 梦游 Explanation Somnambulism, or sleep-walking, is a parasomnia (sleep disorder) during which the sufferer engages in activities normally associated with wakefulness while asleep or in a sleeplike state. Individuals are not completely unconscious while sleep-walking, but they have no memory of the sleep-walking episode. Sleep-walking is more commonly experienced in people with high levels of stress, anxiety, or psychological factors. A common misconception is that sleep-walking occurs as part of a dream. However, sleep-walking in fact takes place earlier in the sleep cycle, during slow-wave sleep (SWS; Stage 3 or 4, N2 sleep) (Horne 1988). The proper term applied to those who “act out” their dream is “REM (rapid eye movement) behavior disorder.” As children and young adults have a higher proportion of SWS (up to 80% of the night), they are more likely to have episodes of somnambulism than older individuals. Most cases of somnambulism occur when the person is “awakened” or disturbed during their SWS. They may get up and engage in some activity, with their eyes open, and they may even respond to questions, but they usually go back to sleep if not awakened. A more recent study by Arnulf (Oudiette et al. 2009) reported that, in 71% of participants, short, unpleasant, dreamlike mental activity occurs during sleep-walking and sleep terror episodes, suggesting that people with these sleep disorders may be acting out the last part of a previous longer dream. Individuals who sleep-walk and have sleep

terrors reported more severe daytime sleepiness and had woken from SWS four times as frequently. From a Chinese medicine perspective, sleepwalking can be explained as a partial disconnection of the shen during which hun (ethereal soul) and po (corporeal soul) take over (see Chapter 2). In this case, the hun directs muscular activity. The wandering of the hun can be regarded as the liver releasing its internal wind or the emotions, which normally manifests as anxiety dreams or even nightmares. This may explain why, in adults, somnambulism is more common in stressed individuals. This shows the importance of exploring and treating points such as hun men BL-47 or shen tang BL-44, and in all cases treating shen men HT-7 to calm the shen. All the usual factors that contribute to unsettling the hun and the shen, such as blood vacuity, or blood heat, especially from liver qi stasis and liver fire, contribute to sleep-walking. Points that help the blood and wei qi to return to the liver are therefore indicated: qu quan LR-8 and yang ling quan GB-34. From a synchronizer point of view, the treatment pattern can be refined by palpating the xicleft points of the four extraordinary vessels: ● Jiao xin KI-8 on the yin qiao mai (yin motility vessel) ● Fu yang BL-59 on the yang qiao mai (yang motility vessel) ● Zhu bin KI-9 on the yin wei mai (yin linking vessel) ● Yang jiao GB-35 on the yang wei mai (yang linking vessel) In this case, yang jiao GB-35 is the point of choice, as it helps to relax the sinews. However, sleep-walking may also be a reaction to dreams of confinement and fear that are experienced as nightmares. Hence the kidneys are involved, as in kidney yang vacuity, with the person waking up extremely tired. Two classical points have been described for sleep-walking: an mien I EX-HN-52 and an mien II EX-HN-53 (see Chapter 3). See also Chapter 3, Cases 6, 12, and 15.

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Patterns and Treatments Heart Blood Vacuity Symptoms ● Difficulty falling asleep ● Anxiety, restless sleep, frequent waking ● Dreams, nightmares, dreams of flying ● Occasional sleep-walking, aggravated by fatigue ● Palpitations, dizziness, blurred vision ● Poor memory, problems concentrating, feeling spaced out ● Tongue and face: pale ● Pulse: choppy or weak Treatment Invigorate blood, supplement heart blood, quiet and settle the shen: shen men HT-7, xin shu BL-15, gan shu BL-18, shen tang BL-44, hun men BL-47, gao huang shu BL-43, ju que CV-14, shen feng KI23, ling xu KI-24, hou ding GV-19, san yin jiao SP-6, pi shu BL-20, ge shu BL-17, zu san li ST-36, yin tang EX-HN-3. Liver Blood Vacuity with Liver Qi Stasis Symptoms Restless sleep, fan (restlessness), waking early, vivid dreams ● Night-walking aggravated by emotions ● Internal wind symptoms, eye symptoms ● Chest oppression, hypochondrial tension, depression ● Irregular cycles, premenstrual breast distension ● Tongue: pale sides (possibly with pale red spots) ● Pulse: choppy or wiry ●

Treatment Invigorate and supplement liver blood, mobilize liver qui, quiet and settle the shen: gan shu BL-18, pi shu BL-20, ge shu BL-17, shen shu BL-23, qu quan LR-8, and san yin jiao SP-6; tai chong LR-3, qi men LR-14, gong sun SP-4; an mien I EX-HN-52 or an mien II EX-HN-53. Liver Fire Symptoms Restless sleep, frequent nightmares, waking early ● Night-walking, worse during emotional periods ● Anger, irritability, envy, and jealousy ●

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Headaches Liver symptoms, internal wind Bitter taste, nausea, red face, dark urine, dry stools Tongue: red sides, dry yellow coating Pulse: rapid and wiry

Treatment Extinguish liver fire, clear heat, subdue wind, settle the shen and the hun: xing jian LR-2, xia xi GB-43, nei ting ST-44, wan gu GB-12 or an mien EX-HN-54, feng chi GB-20, gan shu BL-18, hun men BL-47, bai hui GV-20, either ben shen GB-13 or tou lin qi GB-15, and shen ting GV-24; also treat the kidney. Phlegm Fire Harassing the Mind Symptoms ● Difficulty falling asleep through anxiety ● Nightmares, dreams of flying, sleep-walking ● Mental and emotional agitation ● Bright eyes, loud voice, daring character ● Always feeling hot, bitter taste, nausea ● Tachycardia; hypertension, heart diseases ● Tongue: red, red tip, yellow greasy coating ● Pulse: rapid, overflowing, or slippery Treatment Clear fire, transform phlegm and open the orifices, calm and settle the shen: jian shi PC-5, lao gong PC-8, shao fu HT-8, jue yin shu BL-14, xin shu BL-15, zhong wan CV-12, shui fen CV-9, feng long ST-40, shen men HT-7, shao fu HT-8, ju que CV-14, shen feng KI-23, hou ding GV-19, jiu wei CV-15, jian shi PC-5. Blood Stasis/Heart Blood Stasis Symptoms ● Anxiety when lying down, restless sleep ● Dream-disturbed sleep, sleep-walking ● Palpitations ● Chest pain, angina ● Tongue: purple, or purple spots ● Pulse: choppy Treatment Invigorate blood, expel heart blood stasis, move qi, calm the shen: nei guan PC-6, shen men HT-7, tong li HT-5, shen feng KI-23, jue yin shu BL-14, xin shu

Sleep-talking—Meng Yi 梦呓

BL-15, ge shu BL-17, xin shu BL-15, gao huang shu BL-43, he gu LI-4, tai chong LR-3. Kidney Yang Vacuity, Accompanied by Heart Yang Vacuity Symptoms ● Superficial sleep, insomnia from anxiety ● Night-walking, waking up exhausted ● Easily startled, timidity, indecisiveness, cold with emotions ● Dislike of cold ● Lumbar pains, frequent urination ● Palpitations (arrhythmia) ● Shortness of breath, fatigue, depression ● Tongue: pale, bluish ● Pulse: slow, deep Treatment Supplement yang of heart and kidney, calm shen fortify zhi: shen men HT-7, tai xi KI-3, xin shu BL-15, shen shu BL-23, zhi shi BL-52, ju que CV-14, ling xu KI-24, shen cang KI-25, ming men GV-4, da zhui GV-14, bai hui GV-20.

Sleep-talking—Meng Yi 梦呓 Explanation Somniloquy, or sleep-talking, is a parasomnia that refers to talking aloud in one’s sleep. It can range from simple sounds to long speeches, although these are not always comprehensible. Sleep-talking, like sleep-walking, usually occurs during transitory arousal from non-rapid eye movement (non-REM) sleep. It may also occur during REM sleep, when there is a breakdown of the normal motor atonia. Sleep-talking can occur on its own or as a feature of another sleep disorder such as: ● REM behavior disorder ● Sleep-walking ● Night terrors (intense fear, screaming, shouting) ● Sleep-related eating disorder Sleep-talking is very common in young children (50%), it may persist into adulthood (4% of adults), and it is more frequent during fevers. Polysomnography shows that episodes of sleep-talking may occur during any stage of sleep.

In Chinese medicine, sleep-talking involves a partial activation of the shen, hence the speaking. Again, any factor contributing to unsettling the shen, especially blood heat, can promote sleeptalking. Points that calm the shen and affect speech, such as shen men HT-7 and tong li HT-5, are indicated for all sleep-talking. Sleep-talking is also sometimes referred to as gui (ghost) talk. In the Bai Zheng Fu (Ode of One Hundred Patterns) (Gao Wu Ming 1529), tian fu LU-3 is indicated for this condition. See also Chapter 3, Case 15.

Patterns and Treatments Heart Fire Symptoms ● Difficulty falling asleep through anxiety ● Nightmares, dreams of flying, sleep-talking ● Mental and emotional agitation ● Bright eyes, loud voice, daring character ● Always feeling hot and thirsty ● Tachycardia; hypertension, heart diseases ● Tongue ulceration; bitter taste ● Tongue: red, red tip, yellow coating ● Pulse: rapid, overflowing Treatment Clear heart fire, supplement heart yin, quiet and settle shen: shen men HT-7, shao fu HT-8, tong li HT-5, lian quan CV-23, jue yin shu BL-14, xin shu BL-15, shen tang BL-44, ju que CV-14, shen feng KI23, hou ding GV-19, jiu wei CV-15, jian shi PC-5. Blood Stasis / Heart Blood Stasis Symptoms ● Anxiety when lying down, restless sleep ● Dream-disturbed sleep, sleep-talking, sleepwalking ● Palpitations, chest pain, angina ● Tongue: purple, or purple spots ● Pulse: choppy Treatment Invigorate blood, expel heart blood stasis, move qi, calm the shen: nei guan PC-6, shen men HT-7, tong li HT-5, shen feng KI-23, jue yin shu BL-14, xin shu BL-15, ge shu BL-17, xin shu BL-15, gao huang shu BL-43, he gu LI-4, tai chong LR-3.

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Food Stagnation Symptoms ● Restless sleep; frequent dreams, nightmares, sleep-talking ● Abdominal distension, burping, nausea, halitosis (bad breath) ● Greasy skin, acne, red eyes ● Smelly stools ● Tongue: yellow greasy coating ● Pulse: flooding or slippery and rapid Treatment Invigorate the stomach, transform phlegm, move food stasis, settle and clear the shen: wei shu BL21, yin jiao CV-7, zhong wan CV-12, lie que LU-7, jie xi ST-41, zu san li ST-36, tian shu ST-25, liang men ST-21, yin bai SP-1, nei ting ST-44.

Sleep Apnea—Shui Mian Hu Xi Zhan Ting Zong He Zheng 睡眠呼吸暂停综合征 Explanation Sleep apnea is a sleep disorder that is characterized by pauses of at least 10 seconds between breaths during sleep. The episodes occur repeatedly throughout sleep and cause one or more breaths to be missed. The condition results in either neurological arousal, blood oxygen desaturation (more than 3%–4%), or both arousal and desaturation. Sleep apnea is diagnosed by polysomnography (see Chapter 1). The condition is more frequent in elderly men, and it affects about 6.5% of the population (Young et al. 2002). There are three types of sleep apnea: central, obstructive, and a combination of the two. The most frequent type is obstructive sleep apnea (OSA; 84% of cases), during which breathing is interrupted by a physical block to the airflow. The mechanism of central apnea (4% of cases) is unknown. The aggravating factors for all three forms of apnea seem to be age, obesity, diabetes, smoking, alcohol, muscle relaxants, and drugs with central respiratory-depressant effects, such as opiates, barbiturates, benzodiazepines, and many tranquilizers. Generally speaking, those with sleep apnea are

rarely aware that they are having difficulty breathing. Sleep apnea is usually either witnessed by another person or suspected because of its effects, such as morning fatigue and daytime sleepiness. Other symptoms include loud snoring, restless sleep, morning headaches, moodiness, reduced memory, and sexual dysfunction. There is a 30% increased risk of heart attack (Shah et al. 2007) in patients with OSA, as well as a risk of high blood pressure and stroke. There is even evidence of tissue loss in certain brain regions, particularly the mammillary bodies (Kumar et al. 2008), which could explain the memory loss in patients with OSA. There are only a few studies (Freire et al. 2007, Wang et al. 2009, Xu et al. 2009) that have proved the efficacy of acupuncture in the treatment of OSA (Chapter 6). As always, it is important to insist on a personalized treatment. From a Chinese medicine perspective, OSA can be regarded as phlegm obstructing the orifices. This is coherent with the other factors that are present, such as obesity and snoring. From a synchronizer perspective, it is mainly the quality rather than the length of sleep that is disturbed in sleep apnea. This would be more suggestive of the yin and yang wei mai (yin and yang linking vessels). If the palpation of zhu bin KI-9 or yang qiao GB-35 reveals sensitivity, this will help in choosing the right treatment strategy: ● Yin wei mai: nei guan PC-6 with gong sun SP-4; additionally, confluent points such as da heng SP-15 or fu ai SP-16, which help to resolve dampness, or qi men LR-14 to relax the chest, or especially tian tu CV-22 and lian quan CV-23 to relax the throat ● Yang wei mai: wei guan TB-5, possibly with some neck confluent points such as feng fu GV16, ya men GV-15, and feng chi GB-20 A blockage in the nasal passages can affect sleep and cause sleep apnea as well as snoring. We have seen in Chapter 2 that the closing of the eyes is the first manifestation of the wei qi moving inward. Relaxing the eyes helps to relax the nose, as manifested in the deeper breathing that occurs when we fall asleep. Jing ming BL-1 controls this movement through its connections with the stomach and large intestine channels: ying xiang LI-20 → cheng qi ST-1→ jing ming BL-1. Jing ming BL-1, as a major confluent point of yang and yin qiao mai,

Sleep Apnea—Shui Mian Hu Xi Zhan Ting Zong He Zheng 睡眠呼吸暂停综合征

can be regulated by shen mai BL-62 or zhao hai KI-6. Reducing BL-62 or supplementing KI-6 helps the patient to sleep and is helpful in sleep apnea. The second area the wei qi has to pass through is the chest. The chest needs to relax and to loosen up to permit the wei qi to further descend to the zang fu (organs). Relaxing the chest and diaphragm with points such as ge shu BL-17 (relaxes the diaphragm), zong hui TB-7 (helps move wei qi toward the abdomen), jian shi PC-5 (opens the orifices blocked by phlegm and also used for eating disorders), gao huang shu BL-43 (moves blood and helps to relax the chest), shan zhong CV-17 (supports zhong, ancestral qi and breathing), as well as classical points such as yin bai SP-1 and li dui ST45. Local points to help remove the obstruction to the air passages are ying xiang LI-20, bi tong (EX-HN-14), lian quan CV-23, tian tu CV-22, as well as xuan ji CV-21 (helps to relax the chest). In central sleep apnea, points that affect the brain (mostly Window of the Sky points) can be added: feng fu GV-16, ya men GV-15, bai hui GV20, tian zhu BL-10, ren ying ST-9, and feng chi GB20. The combination of all the above points can be added when treating the patterns described below. In general, the treatment should aim to reduce phlegm by supporting the spleen, lung, and kidney. Lifestyle and diet (weight reduction) play a very important role in sleep apnea. There is even some evidence for the positive effects of exercising the air passages through singing or playing certain wind instruments (Puhan et al. 2006).

Patterns and Treatments In practice, as sleep apnea is most frequent in the elderly and often in overweight individuals, it is quite common for several of the following patterns to be found in the same patient, such as spleen and kidney yang vacuity, associated with heart yang vacuity, and complicated by phlegm misting the mind and blocking the orifices. Kidney yang vacuity can also lead to vacuity of the Sea of Marrow. In this case, the sleep apnea manifests as or aggravates a neuro-mental condition, such as amnesia or dementia.

Spleen Qi Vacuity Symptoms Sleep apnea, frequent snoring ● Sleepiness after meals, muzziness of the head ● Chest oppression, heaviness of the limbs ● Lack of appetite, bloating, soft stools ● Spontaneous sweating ● Dull or pale complexion ● Tongue: swollen with tooth marks, white sticky coating ● Pulse: weak or empty ●

Treatment Supplement the spleen and stomach, supplement qi, and dispel dampness: zhong wan CV-12, pi shu BL-20, san jiao shu BL-22, zu san li ST-36, tou wei ST-8, bai hui GV-20, tai bai SP-3, shang qiu SP-5, san yang luo TB-8, li dui ST-45 with either yin bai SP-1 or da du SP-2. Phlegm Misting the Mind Symptoms ● Sleep apnea and snoring ● Daytime sleepiness; mental and physical asthenia ● Dizziness, morning headaches ● Feeling of heaviness; chest oppression ● Blurred vision ● Copious sputum; nausea ● Obesity ● Tongue: swollen with a sticky coating ● Pulse: slippery Treatment Resolve phlegm, supplement the stomach and spleen, and open the orifices: zhong wan CV-12, pi shu BL-20, san jiao shu BL-22, zu san li ST-36, feng long ST-40, tou wei ST-8, jian shi PC-5, san yin jiao SP-6, shui fen CV-9; san yang luo TB-8 (helps open the orifices), tian jing TB-10, chi ze LU-5, shang qiu SP-5, da chong KI-4. Kidney Yang and Spleen Yang Vacuity Symptoms Sleep apnea, sleepiness, possibly episodes of sleep-walking ● Exhaustion upon waking, apathy ● Forgetfulness, mental fatigue ●

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● ● ● ● ● ●

Lack of willpower, depression Dislike of cold Lumbar pains, worse with cold Frequent urination, edema, “cock-crow” diarrhea Tongue: swollen, pale or bluish Pulse: weak and slow

Treatment Warm yang, supplement qi, supplement kidney and spleen yang, and support the ascent of yang: shen shu BL-23, zhi shi BL-52, pi shu BL-20, ming men GV-4, tai xi KI-3, gong sun SP-4, feng fu GV-16, bai hui GV-20, xin hui GV-22, shen mai BL-62, ju gu LI-16.

● ● ● ●

Use local treatment with three to four points to remove obstruction. Only six to eight points should be needled when treating every other day. Eight to 12 points may be used when treating once a week. I usually needle unilaterally except for the local points.

The general strategy for transforming dampness and phlegm requires attention to diet, herbal remedies, and definitely a change of lifestyle and habits. Although the latter is often difficult to initiate, the improved quality of life observed by the patient becomes an incentive to maintain this new lifestyle.

Blood Stasis Symptoms ● Consequence of trauma, stroke, shock, or phlegm ● Sleep apnea, sleepiness, mental lassitude, amnesia ● May be associated with agitated sleep ● Headaches, dizziness ● Chest pain (angina), tumors, painful periods ● Tongue: purple, or purple spots ● Pulse: wiry or choppy Treatment Regulate blood, and move liver qi: ge shu BL-17, yin lian LR-11, da dun LR-1 (moxa), tai chong LR-3, he gu LI-4, gan shu BL-18, gao huang shu BL-43, xue hai SP-10, bai hui GV-20, feng fu GV-16, tian chi PC-1, tian fu LU-3. See also Chapter 3, Cases 16 and 17.

Treatment Strategies The two main objectives are: ● To transform dampness and phlegm ● To remove the local obstructions In practice, frequent treatments are necessary, preferably every other day to begin with, or at least twice a week: ● If the extraordinary vessels are involved, they can be treated once every 10 days with the key point and possibly the appropriate confluent points. ● Treat the pattern using one or two points.

Enuresis and Nocturia—Yi Niao 遗尿 Explanation Enuresis, or bed-wetting, is a parasomnia that causes sleep disturbance in children. Enuresis can be divided into primary enuresis and secondary enuresis, the latter occurring after a 6-month period of continence. In primary enuresis, psychological problems are almost always the result and only rarely the cause of the condition. By contrast, psychological problems—very often the birth of a sibling, family tension, divorce, and so on—are a possible cause of secondary enuresis. I have also observed many cases of secondary enuresis following vaccinations. The emotional impact of enuresis on a child and family can be considerable. Numerous studies report feelings of embarrassment and anxiety in children with enuresis; loss of self-esteem; and effects on self-perception, interpersonal relationships, quality of life, and school performance (Moffatt 1989). Enuresis is more common in boys, and there even appears to be a genetic predisposition (Von Gontard et al. 1999). The incidence of the condition diminishes with age: 25% by age 4, 5%–10% by age 7, and less than 5% by age 10. In adults, the prevalence is 0.5%–2%. Nocturia, or nocturnal polyuria, is the need to get up during the night to urinate. When the frequency of getting up is high, or if the person has

Enuresis and Nocturia—Yi Niao 遗尿

difficulty falling asleep again, nocturia is considered to be a parasomnia, as it interrupts sleep and also disturbs the quality of sleep. Nocturia occurs mainly in the elderly, but may also be observed in some younger adults. Nocturnal polyuria can result simply from too much fluid intake before going to bed (usually the case in the young), or it can be a symptom of a bigger problem, such as sleep apnea, hyperparathyroidism, chronic renal failure, urinary incontinence, bladder infection, interstitial cystitis, diabetes, heart failure, benign prostatic hyperplasia, ureteropelvic junction obstruction, or prostate cancer. From the perspective of Chinese medicine, both enuresis and nocturia have the same zang fu patterns: ● Kidney qi vacuity ● Kidney yang vacuity (congenital in children, acquired in the elderly) ● Kidney yang and spleen yang vacuity ● Spleen qi and lung qi vacuity ● Damp–heat in the lower jiao and bladder According to Julian Scott (1999), enuresis in children is always a manifestation of a weakness in the Lower Gate (xia guan), which is suggestive of a kidney qi vacuity. Often, kidney qi vacuity is the result of a neonatal problem, such as the mother’s condition prior to birth, a difficult birth, or postnatal infantile pathologies affecting the normal development of the kidney qi. In this case, I often add the chong mai (penetrating vessel) to the treatment, especially the points gong sun SP-4 and bai hui GV-20. In many instances, bed-wetting in children accompanies a disorder of sleep arousal in which the child sleeps too deeply and does not feel the need to urinate. Points such as bai hui GV-20 or san yang luo TB-8 help raise the yang to the head. If the cause is possibly emotional, especially related to fear or insecurity, zhi shi BL-52 is highly indicated. See also Chapter 3, Case 14.

Patterns and Treatments Kidney Qi Vacuity Symptoms ● In adults and the elderly: – Frequent urination, especially at night

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– Lumbar pains; fearfulness, weak libido – Sweaty and smelly feet In children: – Enuresis with large amounts of urine – Weak constitution, possibly nervous or even hyperactive In both children and adults: – Tongue: pale – Pulse: weak and deep

Treatment Strengthen kidney qi and the lower orifices: shen shu BL-23, zhi shi BL-52, pang guang shu BL-28, fu liu KI-7, tai xi KI-3, da zhong KI-4, zhong ji CV-3, qi hai CV-6, bai hui GV-20, san yin jiao SP-6, gong sun SP-4. Kidney Yang Vacuity Symptoms ● In adults and the elderly: – Frequent and clear urination, incontinence – Lumbar pains; weak libido, spermatorrhea – Dislike of cold, cold feet, edema – Tinnitus, deafness, forgetfulness, lack of will, apathy ● In children: – Enuresis with large amounts of urine – Weak constitution, possible retardation ● In both children and adults: – Tongue: swollen, pale or bluish – Pulse: weak and slow Treatment Warm the yang (moxa), supplement qi, supplement kidney yang (moxa), and strengthen the lower orifices: shen shu BL-23, zhi shi BL-52, ming men GV-4, fu liu KI-7, tai xi KI-3, da zhong KI-4, zhong ji CV-3, guan yuan CV-4, bai hui GV-20, zu san li ST-36, san yin jiao SP-6, gong sun SP-4, and (in the elderly) gao huang shu BL-43. Kidney Yang and Spleen Yang Vacuity Symptoms ● As above ● Exhaustion upon waking, apathy ● Forgetfulness and mental fatigue ● Dislike of cold ● Frequent urination, edema, “cock-crow” diarrhea

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Tongue: swollen, pale or bluish Pulse: weak and slow

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Treatment Warm the yang, supplement qi, supplement kidney and spleen yang, and support the ascent of yang. Use the same points as kidney yang vacuity and add shen que CV-8 (moxa), tai bai SP-3 (moxa), and shen mai BL-62. Spleen Qi and Lung Qi Vacuity Symptoms ● In adults and the elderly: – Frequent urination, urgency, incontinence – The need to urinate small amounts when lying down – Waking at 3 a.m. – Weak breathing, cough, asthma, frequent colds – Bloating after meals, somnolence, soft stools – Fatigue, apathy, depression ● In children: – Following an external pathogenic episode; listlessness – Enuresis with small amounts of urine – Weak constitution, prone to colds and coughs – Poor appetite, loose stools ● In both children and adults: – Tongue: swollen in the front, pale – Pulse: empty, floating Treatment Strengthen the lung, spleen, and lower orifices: fei shu BL-13, pi shu BL-20, zhong fu LU-1, tai yuan LU-9, lie que LU-7, yin ling quan SP-9, lou gu SP-7, zhong ji CV-3, zhong wan CV-12, shan zhong CV17, zu san li ST-36, shen zhu GV-12 (in children), and (in the elderly) gao huang shu BL-43. Damp–Heat in the Lower Jiao (Lower Burner) and Bladder Symptoms ● In adults and the elderly: – Frequent urination, urgency, pain and difficulty urinating – Dark urine, postmicturition drip – Dry mouth, thirst, constipation, lower abdominal pain

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In children: – Enuresis with strong-smelling urine Restless sleep, tooth grinding, possible nightmares Irritability Tongue: red, sticky yellow coating Pulse: slippery and full and rapid, or wiry

Treatment Clear heat, transform damp, and clear the lower jiao: pang guang shu BL-28, san jiao shu BL-22, zhong ji CV-3, shui dao ST-28, yin ling quan SP-9, san yin jiao SP-6, tai chong LR-3, qu quan LR-8, yin lian LR-1.

Treatment Strategies Quite good results can be expected when treating enuresis in children. In general, I follow a few basic rules: ● Use only a few points per session, usually not more than four to six, especially if using needles. I personally use a mid-laser (30–40 mW), infrared, for children under 10 years of age. ● Do not use the extraordinary vessels, except for chong mai, under the age of 7. One treatment session per week often produces very good results, and in most cases three to four sessions are sufficient. The exception is when there are intricate patterns, such as a residual pathogenic factor, with long-standing qi deficiency complicated by emotional factors. Here, the treatment can take up to several months. In my experience, all the resistant cases I encountered involved family issues that were usually quite difficult to unravel.

Excessive Dreaming—Duo Meng 多梦 Explanation Although dreaming is indispensable to health, excessive dreaming is a type of sleep disturbance in which the individual wakes up feeling tired and even stressed. Dream time, which represents up to 80% of an infant’s sleeping time, drops to about 20%–25% in an adult. Dream time also varies

Excessive Dreaming—Duo Meng 多梦

depending on life events and transitions such as puberty or pregnancy. People tend to dream more when they are learning new skills or during emotional episodes in their lives or certain diseases. Depressed people have up to three times as much REM sleep as those who are not depressed. Dreams affect us on three levels: ● Physiological. This is evidenced by hormonal changes, with the release of adrenaline and other stress hormones; or the increase in heart rate and breathing; or an increased blood flow to the outer genitalia with erection in men and lubrication in women. ● Emotional. According to dream theories discussed in Chapter 1, and especially the psychoanalytic theories further developed in Chapter 5, dreaming has an important role in the processing of disturbing emotions. Studies of dreams have found that about three quarters of dream content or emotions are negative in nature (NPR 2007). ● Mental. The brain EEG shows an intense mental activity during REM sleep. Furthermore, the importance of dreaming in the processing of memory was underlined in Chapter 1. Hence, it can be said that dreaming is hard work and that too much is not good for the body. Dreaming tends to increase toward the middle and end of the night, but fortunately early waking often acts to protect the dreamer from excessive dreaming and its potential harm. In Chinese medicine, patterns that tend to disrupt the shen and especially the hun cause excessive dreaming. Blood vacuity, which affects both the shen and the hun, is the primary cause. Hun can be unsettled in repletion patterns, as seen in heat or in hot phlegm conditions. Other patterns involving heart and kidney not being in harmony combine both vacuity and repletion, and cause visceral agitation and excessive dreaming. The content and significance of dreams are explored in Chapter 5. Excessive dreaming often accompanies light sleep, disrupting the quality of sleep. From a synchronizer perspective, this is suggestive of yin wei mai (that is, zhu bin KI-9 is reactive). In general, in the case of vacuity patterns, the treatment strategy involves bladder shu (transport) points, especially xin shu BL-15, pi shu BL-17, and gan shu BL-18 for blood vacuity. In repletion

patterns, ying (spring) and shu (stream) points are indicated, such as xing jian LR-2 and tai chong LR3, or da ling PC-7 and lao gong PC-8, and so on. The following points have been traditionally indicated for excessive dreaming: ● ● ● ● ● ● ●

Shen men HT-7: frequent waking, excessive dreaming, agitation, sleep-talking Yin bai SP-1: restless sleep, excessive dreaming, agitation, nightmares Li dui ST-45: dream-disturbed sleep, nightmares Hou xi SI-3: dream-disturbed sleep; dreaming of narrow passages Xin shu BL-15: dream-disturbed sleep; dreaming of the dead Ben shen GB-13: excessive dreaming; nightmares Zu qiao yin GB-44: excessive dreaming; nightmares

Patterns and Treatments Heart Blood Vacuity Symptoms ● Difficulty falling asleep, restless sleep; frequent waking ● Frequent dreams, nightmares, dreams of flying ● Palpitations, dizziness, blurred vision ● Poor memory, concentration problems, feeling spaced out ● Tongue: pale ● Pulse: choppy or weak Treatment Nourish heart blood, and calm the shen: shen men HT-7, jue yin shu BL-14, xin shu BL-15, ju que CV14, shen feng KI-23, ling xu KI-24, hou ding GV-19, jiu wei CV-15, jian shi PC-5, san yin jiao SP-6, pi shu BL-20, ge shu BL-17, zu san li ST-36, yin tang EX-HN-3. Liver Blood Vacuity Symptoms ● Restless sleep, waking early, frequent and vivid dreams ● Dizziness, diminished night vision ● Tongue: pale sides ● Pulse: choppy

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Treatment Invigorate and supplement liver blood, mobilize liver qi, quiet and settle the shen: gan shu BL-18, pi shu BL-20, ge shu BL-17, shen shu BL-23, qu quan LR-8, san yin jiao SP-6; an mien EX-HN-54. Liver Yin Vacuity Symptoms ● Restless sleep, waking early, sleep-walking or sleep-talking ● Nightmares, excessive dreaming, irritability ● Dryness of the throat, eyes, skin, and hair ● Feeling of heat, dizziness ● Tongue: dry, peeled sides, may be red ● Pulse: floating and empty, or thin and rapid Treatment Support the liver and kidney yin, and settle the hun: gan shu BL-18, hun men BL-47, qu quan LR-8, san yin jiao SP-6, ting hui GB-2; ben shen GB-13, shen ting GV-24; also treat kidney yin. Heart Qi and Gallbladder Qi Vacuity Symptoms Insomnia from insecurity, light sleep, excessive dreaming ● Nightmares, waking early, difficulty getting up ● Easily startled, timid, lack of will and initiative ● Palpitation, shortness of breath, fatigue ● Tongue: pale, swollen ● Pulse: empty

● ● ●

Tinnitus, lumbar pains Tongue: peeled, red tip, cracks, heart crack Pulse: floating and empty

Treatment Supplement heart and kidney yin, clear empty heat, and re-establish heart–kidney communication (mainly pericardium [xin bao] points): shen men HT-7, yin xi HT-6, fu liu KI-7, da ling PC-7, jian shi PC-5, jue yin shu BL-14, xin shu BL-15, ju que CV-14, shen feng KI-23, hou ding GV-19, jiu wei CV-15, jian shi PC-5, san yin jiao SP-6, guan yuan CV-4; also yong quan KI-1, zhao hai KI-6, shen shu BL-23, shen tang BL-44, and zhi shi BL-52. Liver Fire Symptoms Restless sleep, intense nightmares, waking early ● Anger, irritability, envy, and jealousy ● Headaches, dizziness ● Tightness in the chest, sides, and hypochondrium ● Bitter taste, red face, dark urine, dry stools ● Tongue: red sides, dry yellow coating ● Pulse: rapid and wiry ●

●

Treatment Supplement heart and gallbladder qi, and calm the shen: shen men HT-7, qiu xu GB-40, xin shu BL-15, dan shu BL-19, zu qiao yi GB-44, wan gu GB-12 or an mien, zhe jin GB-23, tou lin qi GB-15, ben shen GB-13, shuai gu GB-8, han yan GB-4.

Treatment Clear liver and gallbladder heat, move the qi, and settle the shen and hun: xing jian LR-2, tai chong LR3, zu qiao yin GB-44, wan gu GB-12 or an mien, feng chi GB-20, gan shu BL-18, hun men BL-47, jian shi PC-5, bai hui GV-20, ben shen GB-13, or tou lin qi GB-15 and shen ting GV-24; also treat the kidney. Phlegm Fire Harassing the Mind

This pattern is very common in menopause.

Symptoms ● Difficulty falling asleep through anxiety ● Nightmares, night terrors, dreams of flying ● Mental and emotional restlessness, irritability ● Snoring, chest oppression, nausea, lack of appetite ● Tongue: red, red tip, yellow coating ● Pulse: rapid and slippery

Symptoms ● Difficulty falling asleep, restless sleep, frequent waking ● Dream-disturbed sleep; thirsty at night ● Dry throat, palpitations, night sweats, “five palm” heat

Treatment Clear heat, dissolve phlegm, and calm and settle the shen: jian shi PC-5, lao gong PC-8, da ling PC-7, nei guan PC-6, shao fu HT-8, shen men HT-7, jue yin shu BL-14, zhong wan CV-12, shui fen CV-9, feng long ST-40, li dui ST-45.

Heart Yin and Kidney Yin Vacuity with Empty Heat (Heart and Kidney out of Harmony)

Nightmares—Meng Yan 梦魘

Nightmares—Meng Yan 梦魘 Explanation A nightmare is an unpleasant dream that causes the person to wake up and have strong emotional responses, typically of fear or horror. The dream may contain situations of danger, discomfort, or psychological or physical distress. Such dreams can be related to physical causes such as high fever, stress, or post-traumatic disorder. The person may wake up in a state of distress and may be unable to get back to sleep for some time. Eating before sleeping may also stimulate nightmares (Stephens 2006). Occasional nightmares are commonplace, but recurrent nightmares can interfere with sleep. The occurrence of nightmares seems to be age-related: rare in children under 5, more common in young children (25% experience one nightmare at least once per week), most common in adolescents, and less common in adults (dropping in frequency to about one-third from age 25 to 55) (NPR 2007). Nightmares occur during REM sleep and should be differentiated from night terrors, which occur in non-REM sleep. As the length of REM sleep increases throughout the night, nightmares are more likely to occur in the latter part of sleep. From a Chinese medicine perspective, nightmares are associated with fear. Fear is the primary survival emotion, and first and foremost involves the kidney and consequently the liver. As the hun travels at night and is confronted by various life challenges, some of which are perceived as lifethreatening, the dream is experienced as fearful, hence the nightmare. Conditions that unsettle the hun, such as liver heat or liver yang rising, contribute to the manifestation and frequency of nightmares. Nightmares are much more common in children as they tend to have a weak kidney and an exuberant liver (that is, internal wind). In general, the presence of strong emotions, especially fear in daily life, increases the incidence of nightmares. According to Master J. Yuen, wei qi, as part of yang qi, is rooted in the yuan (source) qi and needs to return to the source, the kidneys. If the wei qi cannot fully complete its return to the source, the individual will experience fear in the form of nightmares, as well as fright wind in the form of seizures. Master Yuen further states that wei qi also moves inward to protect us during the sleep

state against gui influences. This kind of gui commonly manifests as gui zha (ghost oppression), the sensation of someone or something “sitting” or “pressing” on the chest. Bai Zheng Fu (Ode of One Hundred Patterns) (Gao Wu Ming 1529) gives indications for the following, which all manifest as restless sleep: ● Jian shi PC-5 for gui xie (ghost evil) ● Yin bai SP-1 for gui zha ● Li dui ST-45 and yin bai SP-1 for sleeping or dreaming with a heavy sensation on the chest ● Tian fu LU-3 for ghost talk From a synchronizer perspective, nightmares mainly disrupt the quality of sleep; hence, the yin wei mai is most often found to be disturbed (that is, zhu bin KI-9 is reactive). As nightmares occur more frequently in the latter part of sleep, the most common zang fu patterns involve the liver and kidney. This may be of great help in orienting the diagnostic investigation and choosing the therapeutic protocol: ● The middle phase of the night, from a yin wei mai perspective, corresponds to the jue yin channels (liver and pericardium; see Chapter 3). Use nei guan PC-6 with other jue yin points, such as jian shi PC-5, da ling PC-7, zhong chong PC-9 (in children), and xin jian LR-2, as well as the complementary shao yang points, many of which are indicated for these conditions, that is, zu qiao yin GB-44, zhe jin GB-23, tou lin qi GB-15, ben shen GB-13, shuai gu GB-8, han yan GB-4 (in children), and lu xi TB-19. ● The end phase of the night involves the shao yin channels (kidney and heart). Use nei guan PC-6 with zhu bin KI-9, shen men HT-7, shao fu HT-8, yong quan KI-1, and ling xu KI-24, as well as the complementary tai yang points appropriate for nightmares: zan zhu BL-2, tian zhu BL10, xin shu BL-15, and hun men BL-47. However, if the disturbed organizer is the yin qiao mai, the person wakes up, is wide awake, and cannot go back to sleep, and the jiao xin KI-8 is reactive: ● The middle phase of sleep corresponds to the tai yin channels (lung and spleen) (in the yin qiao mai point sequence). Use zhao hai KI-6 with other tai yin points: tian fu LU-3, yin bai SP-1, shang qiu SP-5. ● The end phase of sleep corresponds to the jue yin channels (liver and pericardium). Use zhao

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hai KI-6 with the jue yin points mentioned above. Some classical point indications for nightmares are as follows: Yin bai SP-1

Restless sleep, excessive dreaming, agitation, nightmares

Shang qiu SP-5

Nightmares

Nei ting ST-44

Nightmares, restless extremities

Li dui ST-45

Dream-disturbed sleep, nightmares

Zan zhu BL-2

Nightmares

Tian zhu BL-10

Insomnia from overwork, nightmares

Ben shen GB-13

Excessive dreaming, nightmares

Tou lin qi GB-15

Insomnia, anxiety, nightmares

Zu qiao yin GB-44

Excessive dreaming, nightmares

Additionally, Master Yuen recommends the following points: Yong quan KI-1

For fright wind or panic attacks

Tai xi KI-3

Lack of resources in the dream, shortness of breath

Both yong quan To promote defecation (as constipation KI-1 and tai xi KI-3 could be causing the nightmares) Zhao hai KI-6

Bleed for nightmares in the premenstrual phase or prior to labor due to blood stasis

See also Chapter 3, Cases 3, 7, and 11.

Patterns and Treatments Liver Fire Symptoms ● Restless sleep, intense nightmares, waking early ● Anger, irritability, envy, jealousy ● Headaches, dizziness ● Tightness in the chest, sides, and hypochondrium ● Bitter taste, red face, dark urine, dry stools ● Tongue: red sides, dry yellow coating ● Pulse: rapid and wiry Treatment Clear liver and gallbladder heat, move qi, and settle the shen and hun: xing jian LR-2, tai chong LR-3, zu

qiao yin GB-44, wan gu GB-12 or an mien EX-HN54, feng chi GB-20, gan shu BL-18, hun men BL-47, jian shi PC-5, bai hui GV-20, either ben shen GB-13 or tou lin qi GB-15, and shen ting GV-24; also treat the kidney. Heart Fire Symptoms ● Difficulty falling asleep through anxiety ● Nightmares, dreams of flying ● Mental and emotional restlessness, daring character ● Bright eyes, loud voice, always feeling hot, thirsty ● Palpitations, tongue ulceration, bitter taste ● Tongue: red, red tip, yellow coating ● Pulse: rapid, overflowing Treatment Clear heat, calm and settle the shen: shen men HT7, shao fu HT-8, jue yin shu BL-14, xin shu BL-15, ju que CV-14, shen feng KI-23, yong quan KI-1, hou ding GV-19, jiu wei CV-15, jian shi PC-5. Phlegm Fire Harassing the Mind Symptoms ● As above ● Nightmares, irritability, dysphoria, mania ● Snoring, chest oppression, nausea, lack of appetite ● Tongue: red, red tip, yellow coating ● Pulse: rapid and slippery Treatment Clear heat, and resolve phlegm: jian shi PC-5, lao gong PC-8, shao fu HT-8, jue yin shu BL-14, zhong wan CV-12, shui fen CV-9, feng long ST-40. Liver and Heart Blood Vacuity Symptoms ● Restless sleep, waking early, vivid dreams, nightmares occurring early in the night ● Palpitations, dizziness, tinnitus, reduced memory ● Numbness of the extremities ● Pale face and lips ● Tongue: pale ● Pulse: weak, fine

Night Fright/Night Terror— Ye Jing 梦魘

Treatment Nourish the blood, and calm the shen and hun: xin shu BL-15, gan shu BL-18, pi shu BL-20, ge shu BL-17, shen shu BL-23, hun men BL-47, shen men HT-7, qu quan LR-8, san yin jiao SP-6; an mien EXHN-54. Liver Yin Vacuity with Liver Yang Rising Symptoms ● Restless sleep, waking early, sleep-walking or sleep-talking ● Nightmares, excessive dreaming, irritability ● Dryness of throat, eyes, skin, and hair ● Feeling of heat, headaches, dizziness ● Tongue: dry, red and peeled sides ● Pulse: floating and empty, or thin and rapid or wiry Treatment Subdue liver yang, supplement liver yin, and calm the shen and hun: gan shu BL-18, hun men BL-47, qu quan LR-8, tai chong LR-3, san yin jiao SP-6, feng chi GB-20, ting hui GB-2, ben shen GB-13, shen ting GV-24; also treat kidney yin. Heart and Gallbladder Qi Vacuity Symptoms Insomnia from insecurity, light sleep, excessive dreaming ● Nightmares, waking early, difficulty getting up ● Easily startled, timid, lack of will and initiative ● Palpitation, shortness of breath, fatigue ● Tongue: pale, swollen ● Pulse: empty ●

● ● ●

high places to sing, or to undress and run around madly, for example) Gastritis, thirst, halitosis, hunger, acne, red eyes Tongue: stomach crack, red, yellow dry coating Pulse: flooding

Treatment Clear heat, support stomach fluids, and calm and settle the shen: wei shu BL-21, yin jiao CV-7, zhong wan CV-12, lie que LU-7, jie xi ST-41, zu san li ST-36, liang men ST-21, yin bai SP-1, li dui ST-45, nei ting ST-44. Blood Stasis / Heart Blood Stasis Symptoms ● Anxiety when lying down, restless sleep, nightmares ● Dream-disturbed sleep, sleep-talking, sleepwalking ● Palpitations, chest pain, angina ● Tongue: purple, or purple spots ● Pulse: choppy Treatment Move the blood, and calm the shen: nei guan PC-6, shen men HT-7, tong li HT-5, shen feng KI-23, jue yin shu BL-14, xin shu BL-15, ge shu BL-17, xin shu BL-15, gao huang shu BL-43, he gu LI-4, tai chong LR-3, bai hui GV-20, shen ting GV-24.

Night Fright/Night Terror— Ye Jing 夜惊 Explanation

Treatment Supplement heart and gallbladder qi, and calm the shen: shen men HT-7, qiu xu GB-40, xin shu BL-15, dan shu BL-19, zu qiao yi GB-44, wan gu GB-12 or an mien EX-HN-54, zhe jin GB-23, tou lin qi GB-15, ben shen GB-13, shuai gu GB-8, han yan GB-4. Stomach Heat Symptoms ● Restless sleep, frequent dreams, nightmares ● Needing to eat or drink in order to fall asleep ● Mental restlessness, moving and talking too fast ● Agitation (if extreme: compulsion to climb to

Night terror, also known as sleep terror or pavor nocturnus, is a parasomnia disorder that is characterized by extreme terror and a temporary inability to fully regain consciousness. The individual wakes abruptly from non-REM sleep (SWS), usually with manifestations such as gasping, moaning, or screaming. It is often impossible to fully wake the person, and after the episode he or she normally settles back to sleep without waking, the episode being rarely recalled by the person themselves. Night terror may be experienced at any age, although it is more common in children (15%), especially between the ages of 2 and 6 years. Many

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factors can trigger the episodes, such as emotional stress, high fever, irregular sleep or diet, and even constipation. In adults, night terrors are frequently trauma-related. Unlike nightmares, night terrors usually occur in the early stages of sleep, approximately 90 minutes after sleep onset. Other symptoms may accompany the terror, such as tachycardia, tachypnea, and sweating. From a synchronizer perspective, night terrors mainly disrupt the quality of sleep; hence, the yin wei mai is most often involved (that is, zhu bin KI-9 is reactive). As they occur in the first phase of the night, the tai yin (lung and spleen) channels are involved. The treatment strategy involves using nei guan PC-6 with gong sun SP-4, and the tai yin points tian fu LU-3, yin bai SP-1, and shang qiu SP-5. Night fright, also referred to as gui fright, is often related to the accumulation of tan (phlegm), although many of the patterns seen in the section on nightmares can also produce night terrors, especially in children. Some classical point indications for night terrors are:

Treatment Clear heat, dissolve phlegm, and calm and settle the shen: jian shi PC-5, lao gong PC-8, da ling PC-7, nei guan PC-6, shao fu HT-8, shen men HT-7, jue yin shu BL-14, zhong wan CV-12, shui fen CV-9, feng long ST-40. Other points for fright wind include chi ze LU-5, yin bai SP-1, shang qiu SP-5, yong quan KI-1, and shen dao GV-11.

Jian shi PC-5

Insomnia, night terrors

Han yan GB-4

Night terrors

Treatment Resolve phlegm, supplement the stomach and spleen, and open the orifices: zhong wan CV-12, pi shu BL-20, san jiao shu BL-22, zu san li ST-36, feng long ST-40, tou wei ST-8, jian shi PC-5, san yin jiao SP-6, shui fen CV-9, san yang luo TB-8 (helps to open the orifices), tian jing TB-10, chi ze LU-5, shang qiu SP-5, da chong KI-4.

Shuai gu GB-8

Fear, night terrors

Zhe jin GB-23

Night terrors in infants, insomnia from overwork

Guan yuan CV-4

Insomnia, night terrors

Phlegm Misting the Mind Symptoms ● Night terrors, possibly sleep apnea and snoring ● Daytime sleepiness, mental and physical asthenia ● Dizziness, morning headaches ● Feeling of heaviness, chest oppression ● Blurred vision ● Copious sputum, nausea ● Obesity ● Tongue: swollen with a sticky coating ● Pulse: slippery

See also the previous section on “Nightmares” and Chapter 3, Cases 14 and 17.

Dreams of Flying—Meng Fei 梦飞 Patterns and Treatments Phlegm Fire Harassing the Mind Symptoms ● Difficulty falling asleep through anxiety ● Nightmares, night terrors, dreams of flying ● Mental and emotional restlessness, irritability ● Snoring, chest oppression, nausea, lack of appetite ● Tongue: red, red tip, yellow coating ● Pulse: rapid and slippery

Explanation Dreams of flying are usually reported as pleasant and do not really fall under the causes of sleep disturbance, but they nevertheless signify an underlying disharmony pattern, often that of a yin vacuity with yang rising, usually referred to as floating yang. Chapter 17 of the Huang Di Nei Jing Su Wen relates dreams of flying to an “excess above with a deficiency below.” In Chapter 43 of that text, the significance of dreams of flying, white objects, wars, and beheading and bleeding wounds are related to lung qi vacuity with an external xie qi (pathogenic factor) invading the lung.

Dreams of Falling—Meng Zhui 梦坠

Patterns and Treatments Lung Qi Vacuity Symptoms ● Waking at 3 a.m. (solar time), dreams of flying ● Worry, anxiety, sadness ● Weak breathing, cough, asthma, frequent colds ● Dry skin, loss of hair ● Tongue: swollen in the front, pale ● Pulse: empty, floating Treatment Supplement lung qi, and open the chest: fei shu BL-13, po hu BL-42, zhong fu LU-1, tai yuan LU-9, shan zhong CV-17, nei guan PC-6, bu lang KI-22. In the case of external pathogenic factors, add feng men BL-12, lie que LU-7, and he gu LI- 4. Heart Blood Vacuity

Treatment Clear heat, and settle the shen: shen men HT-7, shao fu HT-8, jue yin shu BL-14, xin shu BL-15, ju que CV-14, shen feng KI-23, yong quan KI-1, hou ding GV-19, jiu wei CV-15, jian shi PC-5. Liver Yin Vacuity with Liver Yang Rising or Liver Wind Symptoms ● Restless sleep, waking early, sleep-walking or sleep-talking ● Nightmares, excessive dreaming, dreams of flying, irritability ● Dryness of throat, eyes, skin, and hair ● Feeling of heat, headaches, dizziness ● Tongue: dry, red and peeled sides ● Pulse: floating and empty, or thin and rapid or wiry

Symptoms ● Difficulty falling asleep, restless sleep, waking frequently ● Frequent dreams, nightmares, dreams of flying ● Palpitations, dizziness, blurred vision ● Poor memory, concentration problems, feeling spaced out ● Tongue: pale ● Pulse: choppy or weak

Treatment Subdue liver yang, supplement liver yin, and calm the shen and hun: gan shu BL-18, hun men BL-47, qu quan LR-8, tai chong LR-3, san yin jiao SP-6, feng chi GB-20, ting hui GB-2, ben shen GB-13, shen ting GV-24; also treat kidney yin.

Treatment Nourish the heart blood, and calm the shen: shen men HT-7, jue yin shu BL-14, xin shu BL-15, ju que CV-14, shen feng KI-23, ling xu KI-24, hou ding GV19, jiu wei CV-15, jian shi PC-5, san yin jiao SP-6, pi shu BL-20, ge shu BL-17, zu san li ST-36, yin tang EX-HN-3.

Explanation

Heart Fire Symptoms Difficulty falling asleep through anxiety ● Nightmares, dreams of flying ● Mental and emotional restlessness, daring character ● Bright eyes, loud voice, always feeling hot, thirsty ● Palpitations, tongue ulceration, bitter taste ● Tongue: red, red tip, yellow coating ● Pulse: rapid, overflowing ●

Dreams of Falling—Meng Zhui 梦坠

This condition is not a sleep disturbance in itself, but it can cause a person to suddenly wake up frightened. Obviously, if this condition occurs regularly, it will affect the quality of sleep and cause emotional stress. Dreams of falling reveal an underlying disharmony, generally a vacuity pattern. Chapter 17 of the Su Wen relates dreams of falling to “repletion below.” This can be: ● An accumulation of cold below, which is consistent with kidney yang vacuity or kidney qi vacuity ● An accumulation of dampness, as seen in spleen and kidney yang vacuity ● Possibly even liver qi stagnation Patterns causing light sleep and fearfulness, as seen in heart and gallbladder qi vacuity, can also provoke dreams of falling and waking with a start.

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The treatment strategy aims to identify and treat the causative pattern. Two points have traditionally been indicated for this condition: ● Di ji SP-8: dreams of dropping, of falling, or of sinking when falling asleep ● Tian yu TB-16: dreams of falling or standing on one’s head

Patterns and Treatments Kidney Yang and Spleen Yang Vacuity Symptoms ● Dreams of falling, maybe episodes of sleepwalking ● Exhaustion upon waking, apathy, sleepiness ● Forgetfulness, mental fatigue ● Lack of willpower, depression ● Dislike of cold ● Lumbar pains, worse with cold ● Frequent urination, edema, “cock-crow” diarrhea ● Tongue: swollen, pale or bluish ● Pulse: weak and slow Treatment Warm the yang, supplement qi, supplement kidney and spleen yang, and support the ascent of yang: shen shu BL-23, zhi shi BL-52, pi shu BL-20, ming men GV-4, tai xi KI-3, gong sun SP-4, di ji SP8, yin bai SP-1, bai hui GV-20, shen ting GV-24, shen mai BL-62, ju gu LI-16. Kidney Qi Vacuity Symptoms ● Dreams of falling ● Frequent urination, especially at night ● Lumbar pains; fearfulness, weak libido ● Sweaty and smelly feet ● Tongue: pale ● Pulse: weak and deep Treatment Strengthen kidney qi: shen shu BL-23, zhi shi BL52, fu liu KI-7, tai xi KI-3, yong quan KI-1, qi hai CV-6, bai hui GV-20, san yin jiao SP-6, gong sun SP4, di ji SP-8.

Heart Qi Vacuity Symptoms ● Superficial sleep, sexual dreams ● Easily startled, timidity, instability ● Palpitations (arrhythmia) ● Shortness of breath, fatigue, depression ● Tongue: pale, swollen in the front, possibly heart crack ● Pulse: empty Treatment Strengthen heart qi, invigorate blood, calm and settle the shen: shen men HT-7, jue yin shu BL-14, xin shu BL-15, ju que CV-14, ling xu KI-24, shen cang KI-25, shen ting GV-24, yin tang EX-HN-3, tian yu TB-16, nei guan PC-6, shan zhong CV-17, qi hai CV-6, zu san li ST-36. Heart and Gallbladder Qi Vacuity Symptoms Insomnia from insecurity, light sleep, excessive dreaming ● Dreams of falling, nightmares ● Waking too early, difficulty getting up ● Easily startled, timid, lack of will and initiative ● Palpitations, shortness of breath, fatigue ● Tongue: pale, swollen ● Pulse: empty ●

Treatment Supplement heart and gallbladder qi, and calm the shen: shen men HT-7, qiu xu GB-40, xin shu BL-15, dan shu BL-19, zu qiao yi GB-44, either wan gu GB12 or an mien EX-HN-54, zhe jin GB-23, tou lin qi GB-15, ben shen GB-13, tian yu TB-16. Liver Qi Stasis, Possibly with Liver Blood Vacuity Symptoms ● Jerking when falling asleep, dreams of falling ● Restless sleep, vivid dreams ● Irritability, moodiness ● Dizziness, eye floaters ● Chest oppression, hypochondrial tension, depression ● Irregular cycles, premenstrual breast distension ● Tongue: pale sides (possibly with pale red spots) ● Pulse: choppy or wiry

Sexual Dreams—Meng Jiao 梦交

Treatment Move liver qi, and supplement liver blood: gan shu BL-18, pi shu BL-20, ge shu BL-17, shen shu BL-23, qu quan LR-8, san yin jiao SP-6; tai chong LR-3, qi men LR-14, he gu LI-4, tian yu TB-16, gong sun SP4, an mien EX-HN-54.

Sexual Dreams—Meng Jiao 梦交 Explanation

Tian zhu BL-10

Insomnia from overwork, nightmares, sexual dreams

Xin shu BL-15

Dream-disturbed sleep, dreaming of the dead, sexual dreams

Shen shu BL-23

Sexual dreams

Patterns and Treatments Heart Qi and Spleen Qi Vacuity Symptoms Difficulty falling asleep, sexual dreams ● Daytime sleepiness, fatigue, weakness ● Palpitations, shortness of breath ● Lack of appetite, bloating, soft stools ● Forgetfulness ● Dull or pale complexion ● Tongue: swollen, pale with tooth marks, white thin coating ● Pulse: weak or fine ●

Sexual dreams occur in no more than 10% of dreams and are more prevalent in the young to mid-teens (Hall and Van de Castle 1966). Partial sexual arousal seems to be consistent with REM sleep, as most men present an erection and women become more lubricated. In some cases, sexual dreams may result in orgasm or nocturnal emission. These are commonly known as wet dreams. Sexual dreams are not considered pathological unless they disrupt the sleep and cause tiredness in the morning. The treatment aims more at regulating the causative factor rather than eliminating the manifestation itself. Excessive sexual dreaming reflects an overactivity of yang qi, usually pericardium heat. If accompanied by spermatorrhea, excessive sexual dreaming signifies an underlying pattern of qi vacuity. Nocturnal emission is a separate pathological condition. There are two types of spermatorrhea (yi jing): ● With dreams: meng yi (dream spillage) ● Without dreams: hua jing (slippery essence), a more severe condition In both cases, the nocturnal emission is either due to qi vacuity, failing to contain or hold the jing (essence) (kidney qi vacuity, kidney yang vacuity, heart and kidney yin vacuity, heart and spleen qi vacuity), or overactivity of yang qi pushing the jing out (liver fire, heart fire, damp–heat in the lower jiao). The latter seems an excellent indication for tian zhu BL-10, which is traditionally indicated for sexual overstimulation. Classical points indicated for sexual dreams are:

Treatment Supplement heart and spleen qi, calm the shen: zhong wan CV-12, pi shu BL-20, xin shu BL-15, zu san li ST-36, san yin jiao SP-6, shen men HT-7, bai hui GV-20; also add zhi shi BL-52 and fu liu KI-7 in case of spermatorrhea. Heart Qi Vacuity Symptoms ● Superficial sleep, sexual dreams ● Easily startled, timidity, instability ● Palpitations (arrhythmia) ● Shortness of breath, fatigue, depression ● Tongue: pale, swollen at the front, possibly heart crack ● Pulse: empty Treatment Strengthen heart qi, calm the shen: shen men HT-7, jue yin shu BL-14, xin shu BL-15, ju que CV-14, ling xu KI-24, shen cang KI-25, nei guan PC-6, shan zhong CV-17, qi hai CV-6, zu san li ST-36 also add zhi shi BL-52 and fu liu KI-7 in case of spermatorrhea.

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Heart Yin and Kidney Yin Vacuity with Empty Heat (Heart and Kidney Out of Harmony) Symptoms ● Difficulty falling asleep, restless sleep, waking frequently ● Dream-disturbed sleep, sexual dreams, sexual overstimulation ● Dry throat at night, night sweats, “five palm” heat ● Tinnitus, lumbar pains, palpitations ● Tongue: peeled, red tip, cracks, heart crack ● Pulse: floating and empty Treatment Supplement heart and kidney yin, clear empty heat, calm and settle shen, and re-establish heart– kidney communication (mainly pericardium points): shen men HT-7, yin xi HT-6, fu liu KI-7, da ling PC7, jian shi PC-5, jue yin shu BL-14, xin shu BL-15, ju que CV-14, shen feng KI-23, hou ding GV-19, tian zhu BL-10, jiu wei CV-15, jian shi PC-5, san yin jiao SP-6, guan yuan CV-4; also yong quan KI-1, zhao hai KI-6, shen shu BL-23, shen tang BL-44, zhi shi BL-52. Pericardium Heat Symptoms ● Difficulty falling asleep through anxiety ● Nightmares, dreams of flying, sexual dreams ● Mental restlessness, overexcitement, sexual perversions ● Always feeling hot, thirsty, tachycardia, hypertension ● Congestion, heart pain ● Tongue: red, red tip, yellow coating ● Pulse: rapid, overflowing Treatment Clear heart and pericardium heat, calm and quiet the shen: jian shi PC-5, nei guan PC-6, da ling PC-7, shen men HT-7, shao fu HT-8, jue yin shu BL-14, xin shu BL-15, ju que CV-14, shen feng KI-23, hou ding GV-19, jiu wei CV-15. Liver Qi Stagnation with Liver Fire Symptoms Restless sleep, nightmares, sexual dreams, waking early

●

● ● ● ● ● ●

Anger, irritability, envy, and jealousy Headaches, dizziness Tightness in the chest, sides, and hypochondrium Bitter taste, red face, dark urine, dry stools Tongue: red sides, dry yellow coating Pulse: rapid and wiry

Treatment Clear liver and gallbladder heat, move the qi, and settle the shen and hun: xing jian LR-2, tai chong LR-3, zu qiao yin GB-44, wan gu GB-12 or an mien EX-HN-54, feng chi GB-20, gan shu BL-18, hun men BL-47, jian shi PC-5, bai hui GV-20, either ben shen GB-13, or tou lin qi GB-15, shen ting GV-24, tian zhu BL-10; also treat the kidney.

Circadian Rhythm Desynchronization Jet Lag Explanation Jet lag is not a pathological condition per se, but the by-product of our modern-day forms of traveling. The crossing of time zones when traveling east or west tends to disrupt the internal body clock. The symptoms may include: ● Fatigue ● Insomnia ● Disorientation or mental confusion ● Nausea or loss of appetite ● Headaches ● Edema These symptoms can last up to 10 days. The duration of the symptoms are estimated to be 1 day for each time zone crossed. In general, traveling eastward (against the earth’s rotation) produces more severe symptoms than traveling westward. Children under the age of 5 seem to be less affected than adults. Circadian rhythms allow organisms to anticipate and prepare for precise and regular environmental changes; for instance, day and night, length of daylight, and seasons. The rhythmicity appears to be just as important in regulating and coordinating internal metabolic processes as in synchronizing with the environment (Sharma 2003).

Circadian Rhythm Desynchronization

Treatment of Jet Lag The treatment of jet lag has three objectives: ● To reset the internal biological clock to the new time zone ● To synchronize the system to the different climate or season at the destination ● To help the organism’s ability to adapt First the four xi points of the extraordinary vessels are explored by palpation:

9–11 Spleen

5–7 Large intestine

Yang m ing Tai y in

7–9 Stomach

11–13 Heart

13–15 Small intestine

17–19 Kidney in

3–5 Lung

Jue y

Shao 1–3 Liver

15–17 Bladder

Ta iy an g

yin

Therapeutic Protocols

Midday

ao Sh

The rhythm of the biological clock is linked to the cycle of light and dark. Scientists have identified a photosensitive protein that is believed to have originated in the earliest cells and has since been transmitted genetically (Nagoshi et al. 2004). This gene has been found to be defective in patients with advanced sleep phase syndrome (Jones et al. 1999). Different cells throughout the body communicate with each other, resulting in the synchronized output of electrical signals. These coordinated electrical signals may interface with endocrine glands in the brain, resulting in the periodic release of hormones (see Chapter 1, “Normal Sleep, Circadian Rhythm”). In mammals, the primary circadian clock is located in the suprachiasmatic nucleus (SCN), which reacts to specific photosensitive ganglion cell receptors in the retina. The SCN passes the information on to the pineal gland, which in response secretes melatonin. Melatonin levels and core body temperature are the classic markers for measuring the circadian rhythm in mammals. It has been established that disruption of the circadian rhythm has significant adverse health consequences on the peripheral organs, such as on cardiovascular diseases (Martino et al. 2008), and may also increase the risk of developing cancer (Straif et al. 2007). In classical Chinese medicine, this well-known body clock has been of fundamental importance both in lifestyle (living in accordance to the midday–midnight rhythm) and in diagnosis and therapy (Fig. 4.1). In energy terms, the desynchronization of the circadian rhythm involves primarily the four extraordinary vessels responsible for synchronizing the inner with the outer factors.

yang

23–1 Gallbladder

19–21 Pericardium

21–23 Triple burner

Midnight

Fig. 4.1 The midday–midnight clock: the Chinese chronobiological clock of qi circulation. The tide and web of qi in the channels and their respective organs.

● ● ● ●

Jiao xin KI-8 on the yin qiao mai Fu yang BL-59 on the yang qiao mai Zhu bin KI-9 on the yin wei mai Yang jiao GB-35 on the yang wei mai

Most often, I have found the yin or yang qiao mai to be reactive. The treatment protocol is as follows: ● Zhao hai KI-6 (supplement on the dominant side: right for women, left for men) ● Shen mai BL-62 (reduce on the opposite side) ● Yin tang (not only calms the shen, but also has a strong effect on the pituitary and SCN) ● With the possible addition of si shen cong Otherwise, as it is the external synchronizer, the time zone that has changed yang wei mai should be considered, especially if yang jiao GB-35 is reactive: ● Wei guan TB-5 ● He gu LI-4 to regulate the quality of sleep in its capacity as regulating the surface and the wei qi. He gu LI-4 also regulates the distribution of ying qi (nourishing qi), wei qi, and blood from the center. For this purpose, tai chong LR-3 can also be added, as it additionally helps to increase the organism’s ability to adapt.

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To synchronize the system to the new climate, I use the seasonal supplementation and reduction points based on the principle of “supplementing the mother and reducing the son.” The treatment is directed at the channels most likely to suffer. For example, when traveling from Europe to South East Asia in winter, we are going from winter into summer. The systems that will most likely suffer are the kidney and heart systems. The seasonal supplementing pounts are the wood points, the reduction points are the earth points. Therefore, the points to use are shao chong HT-9, shen men HT-7, yong quan KI-1, and tai xi KI-3 (Fig. 4.2). Additionally, to help the liver to adapt more easily, da dun LR-1, tai chong LR-3, and so on can be used. When traveling in the opposite direction, from South East Asia to Europe, we are going from summer to winter. The points to choose here are the metal and wood points. The channels to treat are again the kidney and heart, as well as possibly the lung, which easily suffers from the cold: fu liu KI-7, yong quan KI-1, ling dao HT-4, and shao chong HT9, jing qu LU-8 and shao shang LU-11 (Fig. 4.3).

Summer Wood (mother)

Earth (son)

Fig. 4.2 Supplementing the mother and reducing the son to help the transition into summer.

Wood (son)

Winter

Metal (mother)

Fig. 4.3 Supplementing the mother, reducing the son to help the transition into winter.

Insomnia 1

Shen men Zero point Pituitary gland

Insomnia 2

Pineal gland Master omega (Master cerebral)

Fig. 4.4 Auricular points for the treatment of jet lag.

Additionally, if the patient has a known propensity to a certain weakness, the corresponding channels are also treated. For example, if the person has a tendency to present constipation when traveling, the mother–son points of the large intestine may be added, in this case shang yang LI-1 and san jian LI-3. The treatments are given daily, maybe even twice a day, using four to six points only per session. Auriculotherapy is also quite effective in alleviating the disturbed sleep patterns, disorientation, and other symptoms that accompany jet lag (Fig. 4.4): ● Shen men ● Zero point ● Insomnia 1 and 2 ● Pineal gland or pituitary gland ● Omega point Master Yuen proposes an ancient Ming dynasty point combination for resetting the biorhythms and balancing the hormonal system (Yuen 2008). This point combination was referred to as the “Inner Four Gates.” Originally the Four Gates were the last points of the zu jue yin LR channel, qi men LR-14, combined with the first points of the shou tai yin LU channel, zhong fu LU-1 to re-establish the day–night balance and harmonize the post-heaven (postnatal) qi. Later for practical reasons, the chest points were replaced by distal points, tai chong LR-3 and he gu LI-4, this becoming the “Outer Four Gates” as we know them today. These four points are then complemented by bai hui GV-20 and zhong wan CV-12 to balance the pre-heaven (pre-natal) energies. By adding jing ming BL-1, this combination

Circadian Rhythm Desynchronization

Fig. 4.5 Resetting the biorhythms.

(6) GV-20

(7 & 8) BL-1

(2) LU-1

(4) LU-1

(5) LR-14

(3) LR-14

(1) CV-12

becomes an interesting treatment option for all disturbances of the biological clock as experienced in jet lag or shift work. I recommend the following needling order: starting with CV-12, then LU-1 on the right side for women (left for men), followed by LR-14 on the opposite side, followed by LU-1 on the opposite side, followed by LR-14 on the same side (creating a figure 8), then GV-20, ending with BL-1 on both sides (Fig. 4.5); yin tang EX-HN-3 may alternately replace BL-1.

Table 4.1 The time phases and points of the primary channels Channel

Time

Pen (horary) element point

Lung

3 a.m.–5 a.m.

Jing qu LU-8

Large intestine

5 a.m.–7 a.m.

Shang yang LI-1

Stomach

7 a.m.–9 a.m.

Zu san li ST-36

Spleen

9 a.m.–11 a.m.

Tai bai SP-3

Heart

11 a.m.–1 p. m.

Shao fu HT-8

Preventing Jet Lag

Small intestine

1 p. m.–3 p. m.

Yang gu SI-5

There are two protocols for avoiding jet lag. Both use the element points, also known as horary or pen points, in order to reset the biological clock to the new time zone (Table 4.1): 1. At the time of departure, the watch is set to the time at the destination. The current time at the destination is found in Table 4.1. 2. The acupuncture point corresponding to that time period is identified.

Bladder

3 p. m.–5 p. m.

Zu tong gu BL-66

Kidney

5 p. m.–7 p. m.

Yin gu KI-10

Pericardium

7 p. m.–9 p. m.

Lao gong PC-8

Triple burner

9 p. m.–11 p. m.

Zhi gou TB-6

Gallbladder

11 p. m.–1 a.m.

Zu lin qi GB-41

Liver

1 a.m.–3 a.m.

Da dun LR-1

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3. The point is stimulated on both sides either with a needle for 5 minutes, or by acupressure 25–30 times. Personally, I use a hand-held infrared laser to stimulate these points. 4. The point corresponding to the next time period (Table 4.1) is stimulated every 2 hours. 5. I advise continuing the process for a few hours after arriving. Amaro (2002) proposes working through the cycle until one reaches the point one started from. For example, when traveling from Paris to Los Angeles, a departure time of 11 a.m. in Paris corresponds to 2 a.m. in Los Angeles (liver time). Start by stimulating da dun LR-1; then, 2 hours later, stimulate the next point jing qu LU-8, 2 hours later shang yang LI-1, and so on. If one sleeps through the next time period, the stimulation is resumed upon waking with the channel corresponding to the time upon waking. The stimulation is continued for several hours after arriving or until one full cycle has been completed. The other and older protocol calls for stimulating the appropriate points of both channels active at the time of departure and destination. For example, if the departure time from Paris is 11 a.m., the pen point of the heart, shao fu HT-8, is selected together with da dun LR-1, the pen point of the liver, as this would correspond to the channel active at the time of destination, which would be 2 a.m. in Los Angeles. I find this protocol, however, to be less practical and somehow less logical. I also highly recommend fasting during the flight but drinking sufficient water. Eating should be resumed only at the appropriate meal time at the destination. This helps to set the inner synchronizers to the local time zone.

Shiftwork Another cause of circadian rhythm disruption is shiftwork. Shiftwork sleep disorders (SWSD) are characterized by insomnia and excessive sleepiness at nonstandard times, causing the same type of symptoms as with insomnia, that is, impaired mental acuity, irritability, reduced performance, and increased risk of accidents. There is even a possibility of an increased risk of cancer (Straif et al. 2007). Generally speaking, younger people adapt much more easily to changes in working and sleeping times. In addition, the negative effects of shiftwork appear to be alleviated when the shifts are progressive, the person, for example, working from 7 a.m. to 3 p. m. for a few days, then from 3 p. m. to 11 p. m. for a few days, and then from 11 p. m. till 7 a.m., rather than working nights for a week and then days for the next week. I most often find the yin or yang qiao mai reactive in shift workers. The treatment protocol is as follows: ● Zhao hai KI-6 (supplement on the dominant side: right for women, left for men) ● Shen mai BL-62 (reduce on the opposite side) ● Yin tang EX-HN-3 Resetting the Inner Four Gates with zhong wan CV-12, zhong fu LU-1, qi men LR-14, bai hui GV-20 and jing ming BL-1; the latter may be replaced by yin tang EX-HN-3. Another alternative would be to reset both the Inner and Outer Four Gates: LR-3, LI-4, followed by LR-14 and LU-1, CV-12 and GV-20, needled in a similar order as described previously. See also Chapter 3, Cases 2 and 4.

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5

Dreams and Their Significance in Chinese Medicine

Modern Western and Ancient Eastern Theories about Dreams Dreams are the least understood part of sleep and have been the subject of religious and philosophical fascination since the dawn of humanity.

Greek Mythology In ancient Greek mythology, Morpheus, the son of Nyx, goddess of the night, is considered to be the god of dreams, with the power to send dreams or visions and to give them any form or shape. With his brothers Phobetor, the maker of fearsome dreams, Phantasos, the bringer of unreal dreams, and the twins Hypnos, the god of sleep, and Thanatos, the god of death, he presides over sleep. Morpheus, the god of dreams, is considered superior to all of his brothers. The Greek temples known as “Asclepieions” were built for curing the sick by divine intervention through dreams. Dreams were also considered to be omens, as described in the Oneirocritica (The Interpretation of Dreams) (Artemidorus 2nd century CE).

Middle Eastern Traditions The Babylonian “Epic of Gilgamesh” is one of the earliest written examples of dream interpretation (Thompson [1928], 2007). In ancient Egypt, priests interpreted people’s dreams. The Bible cites many dreams as divine revelation, and it is recorded that Daniel became known for his skill in dream interpretation in the Babylonian court (606 BCE). Joseph, as cited in the Book of Genesis, was made viceroy of Egypt after interpreting the Pharaoh’s dreams. The early Muslim scholars recognized three types of dream (false, pathogenic, and true dreams). An important treatise on dream interpretation was written by Ibn Sirin (654–ca. 728), and

another on Sleep and Dreams by Al-Kindi (ca. 801– ca. 873). The famous Persian physician Ibn Sina (980–1037), known as Avicena, included the study of dreams in his Canon of Medicine.

Hindu Traditions Many Eastern traditions have emphasized the importance of dreaming and have proposed working with dreams as a means of self-liberation. In the Hindu yoga traditions, Yoga Nidra refers to yogic sleep, and yogic lucid dreaming (see below) has been practiced for millennia by Sadhu and Rishi adepts. The Hindu scripture Mandukya Upanishad (1st–2nd century CE) describes three common states of consciousness—waking, dreaming, and deep sleep—plus a fourth state, Turiya, or pure consciousness (Rama 1982). Yoga Nidra refers specifically to the conscious awareness of the deep sleep state, referred to as “Prajna.” Today, Yoga Nidra is taught not only as a meditation, but also as a relaxation practice. Popularized in the West by Swami Satyananda since the 1980s, it has been shown to reduce tension and stress and to enhance sleep (Kumar 2005, 2006). In an attempt to understand the neurophysiological impact of Yoga Nidra, Swami Rama, a Hindu yogi, was extensively studied at the Menninger Foundation, where he demonstrated a variety of extreme abilities, including Yoga Nidra, which is a voluntary death-like state of physiological arrest (Anand et al. 1961). Dreams are a reservoir of knowledge and experience, yet they are often overlooked as a vehicle for exploring reality. Tarthang Tulku Yoga

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5 Dreams and Their Significance in Chinese Medicine

Buddhist Tradition Dreams and dream practice occupy an important place in the Buddhist tradition too. Buddha Shakyamuni summarizes the source of human suffering in four fundamental truths. The first is that all phenomena have an illusory nature, as in dreams. In the Dzogchen school of Tibetan Buddhism, Dream Yoga, or Milam, comprises a set of advanced tantric processes and techniques described in the Six Yogas of Naropa. According to the contemporary Dzogchen teachers Namkhai Norbu, Lopön Tenzin Namdak, and Tenzin Wangyal, perceived reality and the phenomenal world are considered ultimately to be an illusion (Maya), a dream, simply a thought-form. Quantum field theory in modern particle physics might ultimately confirm this ancient belief. What gives the apparent solidity to material reality is our beliefs and attachments (Samskara). In Dream Yoga, the living may become the dream, and the dream may become the living. According to this teaching, there is also a relationship between the states of sleeping and dreaming and our experiences when we die. After traversing the intermediate state between two life incarnations called the Bardo, a new karmic illusion is created and another existence begins. The primary aim of dream practice is to realize during a dream that one is dreaming; this is referred to as “lucid dreaming” (see below). With this comes an understanding of the dreamlike nature of daily life, fundamental to reducing attachments, which are based on strong beliefs that life’s perceptions and objects are real and, as a consequence, important. The realization that life is only a big dream can help us finally liberate ourselves from the chains of emotions, attachments, and Ego, and ultimately leads to enlightenment (Norbu 1992, Wangyal 1998). The six stages of lucid dreaming practice are: ● First stage. The dreamer learns to become lucid in the dream. ● Second stage. The dreamer overcomes all fear of the contents of the dream. ● Third stage. The dreamer contemplates the illusory and changing nature of all phenomena, both in the dream and in waking life. ● Fourth stage. The dreamer realizes that we have control over our dreams. ● Fifth stage. The dreamer realizes that the dream

●

body is as insubstantial as the other objects in the dream. Sixth stage. The dreamer lucidly visualizes the images of deities serving as symbolic doorways to this mystical state of being (the Void or clear light).

Chinese Tradition In the Chinese tradition, ming 命, translated as “life” or “mandate” or “life mandate,” represents the sum total of the requirements that the soul has to fulfill throughout a given life (or incarnation). Master J. Yuen refers to this life mandate as the “life curriculum.” The ming is considered to carry the yun 运 , destiny or fortune, and is stored in the kidneys. In Western terms both ming and yun are often understood as destiny. In the Chinese physiology of sleep, dreaming is the domain of the hun (ethereal spirit or soul), which resides in the liver. The liver is considered to be the “record-keeper.” Not only does it help to bring events from the subconscious into the conscious mind, but it is also believed to keep the “memory of the future,” that is, our life curriculum (Chen Shi Yuan in Meng Zhan Yi Zhi, 1562). In Chinese embryology, a fetus starts dreaming at the age of 5 lunar months, when the five senses are fully developed. It is believed that, at this time, the future baby communicates through dreams with the mother and even tells her its name. This curriculum will first manifest itself in the development of the embryo, as supervised and carried out by the chong mai (penetrating vessel) manifesting in the constitution and morphology. After birth and consolidation of the kidney qi, the qiao mai (motility vessels), and wei mai (binding or linking vessels) coordinate the unfolding of the curriculum through 7- and 8-year cycles (Su Wen, Chapter 1). This coordination defines important physiological landmarks, such as childhood, adolescence, and maturity (maturescence), as well as psycho-spiritual developments. The French school defines these life passages as “gates” and proposes the following correspondence with the yang wei and yang qiao extraordinary vessels:

Modern Western and Ancient Eastern Theories about Dreams

The three gates and the extraordinary vessels: Ankle Gate

Childhood

BL-61 pu can

Hip Gate

Puberty

GB-29 ju liao

Shoulder Gate

Maturity

SI-10 nao shu

Here, BL-61 is the constituent point of yang qiao mai; and GB-29 and SI-10 are the constituent points of both yang qiao mai and yang wei mai. Master Yuen is more precise here, stating that the channels responsible for the life cycles (multiples of 7 and 8 years) are the yin and yang wei mai. At the end of our life curriculum, the yin and yang return to the constitutional level in preparation for rebirth, a new beginning. This is represented by the point sequence of yin and yang wei mai. The yin wei goes to qi men LR-14 (the yin aspect of wood) before returning to the yin, the ren mai (conception vessel) at lian quan CV-23. Yang wei ends at feng chi GB-20 (the yang aspect of wood), and then returns to the yang, the du mai (governing vessel) at ya men GV-15 and feng fu GV-16. Wood represents renewal, and what we have not been able to process in our lives returns in the form of new challenges, hence the importance of the opening points of these two channels—nei guan PC-6 and wei guan TB-5—for dealing with the challenges in our lives. The liver, which acts as an emissary between the kidney and the heart, represents the link between the deposited destiny, ming, and the spiritual life transitions. The shen, being responsible for our spiritual evolution, will manifest through the offices of the hun in the form of dreams, enacting the challenges of our chosen life curriculum. The hun stored in the liver will explore these life challenges, helping to bring them into our consciousness and to prepare us for these events through dreams, especially prophetic dreams. Through the practice of lucid or conscious dreaming, one can process these challenges. When there are difficulties in this processing, the dream is experienced as a nightmare. As we have previously seen in Chapter 2 (see “Shen: Mental Relaxation,” p. 21), the points on the heart channel symbolically represent the main stages of each person’s spiritual evolution. According to Master Yuen, the liver plays a central role in all four stages of sleep: ● In the first stage of sleep, relaxation is enabled

by the liver and lungs. ● ● ●

In the second stage, the liver interacts with the spleen to maintain sleep. In the third stage, the liver interacts with the kidneys to allow for deep sleep. Ultimately, the interaction of the liver with the heart or pericardium allows for lucid dreaming or vivid awareness during the dream state.

The purpose of this lucid dreaming is: ● To bear witness or at least prepare oneself to observe the events of the past and future (enabled by the hun) and to observe our reactions to these events (enabled by the pericardium). ● Eventually, to consciously place ourselves in a challenging situation and to develop the “solutions” or “resolutions”. The Chinese medical literature, Huang Di Nei Jing Su Wen, commonly known as Nei Jing (Inner Classic or Inner Canon), and Ling Shu (Spiritual Pivot), extensively analyze the pathological significance of dreams as indicators of organ disharmony (see later in this chapter). Besides this use of dreams for medicinal diagnostic purposes, earlier cultures— mainly Daoism and Confucianism—placed important emphasis on dream interpretation: A dream is that which can be considered real when asleep. Mo Zi (4th Century BCE) A dream not interpreted is like a letter not read. The Talmud In the Daoist tradition, the nature of reality and of all phenomena is attributed to the Void: Thirty spokes converge on a hub, but it is the emptiness that makes a wheel work pots are fashioned from clay but it is the hollow that makes a pot work windows and doors are carved for a house but it is the spaces that make a house work existence makes something useful but non-existence makes it work. Lao Zi (6th century BCE), Dao De Jing, verse 11 (translated by Red Pine [aka Bill Porter], published by Mercury House, 1996)

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Of course, the question of the dreamlike nature of reality occupies an important place in Daoist literature: Once upon a time, I, Zhuang Zi, dreamt I was a butterfly, fluttering hither and thither, to all intents and purposes a butterfly. I was conscious only of my happiness as a butterfly, unaware that I was Zhuang Zi. Soon I awaked, and there I was, veritably myself again. Now I do not know whether I was then a man dreaming I was a butterfly, or whether I am now a butterfly, dreaming I am a man. Zhuang Zi (4th century BCE) The paradox of the dreamlike nature of life and the similarity of death to sleep is again underlined in a statement by the Sophist Hui Zi: One can die and be born at the same moment. Hui Zi (4th century BCE) The Daoist tradition distinguishes between three types, or categories, of dream: ● Dreams that allow the opposite belief to be, or expressing what is suppressed ● Dreams that question reality and develop the imagination ● The great awakening (life is like a dream), dreams representing a portal to awakening Life is a preparation for death, life is like a dream, death is an awakening. Zhuang Zi (4th century BCE) Zhuang Zi further states that a person in a state of self-realization or enlightenment does not need to dream. Therefore, the analysis of dreams in Chapter 17 of the Nei Jing falls into the first category, in a way expressing the hidden, that is, the organic vacuity, and the repletion of the xie qi (pathogenic qi). Confucianism considers the role of dreams to be: ● Teaching us to become a better person ● As prophecies, measured by analyzing the Ghanzi stems and branches or Chinese astrology and considering seasonal or climatic influences in the interpretation of dreams

During the Tang dynasty of the 7th century CE, three types of “unusual” dream were described: ● Events occurring simultaneously in faraway places, notion of resonance ● Two persons dreaming the same dream ● Dreams of doubting, not knowing if an event was an illusion or reality But the most interesting records from this time are dreams of death that are very similar to the modern-day near-death experiences. According to Master Yuen, these death dreams probably led to points being developed to bring a person out of this near-death (deep sleep) state. During the Ming dynasty (16th century), Gao Wu recorded the nine points to return yang (resuscitate), which are useful for dying patients to help the process of dying, or to assess whether a patient is actually ready to die and help during the three stages of dying: ● First stage—when one starts to see one’s loved ones: ya men GV-15, lao gong PC-8, san yin jiao SP-6 ● Second stage—disorientation and losing consciousness: yong quan KI-1, tai xi KI-3, zhong wan CV-12 ● Third stage—the comatose stage, to resuscitate: huan tiao GB-30, zu san li ST-36, he gu LI-4 These points are used according to the manifestations, and only one stage is treated at a time. With the revival of Confucianism during the Song dynasty in the 11th century, dreams were considered to allow qi to follow li (principle). That is, dreams were believed to teach us. Dreams were considered to be directed by the zhi (will). It was therefore recommended to establish the theme of the recurring dream, and then work on the zhi that produced that particular dream by working on the relative bladder back shu points added to ying (spring) and shu (stream) points. Therefore, for a recurring dream with a wood theme, gan shu BL18 or dan shu BL-19, xing jian LR-2, tai chong LR-3 would be used. As dreams were considered to release memories via the hun, working with the liver and the kidneys was recommended. The most important textbook on dream interpretation was written during the Ming dynasty by Chen Shi Yuan (1516–1595) and was called Meng Zhan Yi Zhi (Analysis and Conclusion of Dreams). This was published in 1562, and was compiled

Modern Western and Ancient Eastern Theories about Dreams

from various sources, including the Nei Jing. Chen Shi greatly emphasized the importance of studying dreams, and he believed that dreams are the wandering of the hun. Chen Shi Yuan maintained that the qi of the tian (heaven) produces hun (liver blood), and that the qi of the di (earth) produces po (corporeal soul; lung yin). When qi is pure, po follows hun. When qi is turbid (phlegm), hun follows po. In other words, strange dreams that we can relate to in some way come from liver blood. But if the dream topic is strange and unknown, it comes from lung phlegm. He also believed that the hun knows the future (aspirations). Po conceals the past (what we cannot let go of). This is called the gui (earth-bound spirit, ghost). The gui can affect the po and cause it to wander, sometimes resulting in seminal loss. In chapter 7 of the Meng Zhan Yi Zhi, there is a more elaborate classification of dreams: ● Normal dreams. These are often forgotten. They are the result of harmony between the five phases, especially the five emotions. There is often a varied range of emotional manifestations during the dream, but the person feels good upon waking. Through these dreams, the zang (organs) are capable of releasing some emotion, and the person wakes up feeling good and rested. The most regenerating of dreams are those which go through the full range of the emotions. These are considered normal dreams. ● Nightmares are unsettling and often unusual dreams that wake the sleeper up in an uncomfortable state. They are associated with the kidney. ● Waking thoughts are dreams involving thoughts one had before falling asleep. They involve the spleen. ● Waking words are dreams that involve what was said before going to sleep. Speech concerns the tongue, hence corresponds to the heart. ● Happy, celebrating dreams are associated with the lung. ● Fearful dreams involve the gallbladder. Chen Shi Yuan analyzes the factors that affect dreams, as commented on by Master Yuen: ● Environmental factors: – Including settings, such as sleeping at home or in a strange bed or even outdoors, as well as climatic factors, exposure to heat, wind, draft, and so on

●

●

– The state of relaxation of the sinews during sleep – The environmental factors can be associated with the wei qi (defensive qi): the movements of wei qi were discussed in Chapter 2. Social factors—the influence of culture and values: – Based on cultural definitions, some dream symbols represent concepts that have significance only for a particular culture. In other words, there is no concept of universality in dream symbolism. Social values also include notions of rewards and punishments, or death and dying. They are relevant in a society that emphasizes ancestral worship. Dreaming about a dead person often signifies unfinished business with the deceased. This is believed to be holding back a dead person, and it is good to resolve the issue. – Based on family myths or predispositions, especially dreaming of diseases that run in the family. These issues have to be explored and treated, as they may become reality. – Based on one’s own personal experiences and interactions with the objects in the dream, for example loss, theft, death, nature, heights, status, and so on – The social factors may be associated with the ying qi. Constitutional factors: as related to the yuan (source) qi: – Dreams could be reflections of one’s primitive need to survive and basic drives, especially in the form of competition. – Dreams can be signposts or omens of our ming. They provide good clues to our ancestral sensitivities.

The assessment of the dream’s influencing factors enables us to choose the level that is affected (wei, ying, yuen, or jing) and the appropriate channel system to be used: ● For exogenous factors, wei qi level, use jing jin (sinew channels), the tai yang (supreme yang), and the jing (well) points. In case of recurring themes of a certain climate, consider the jing bie (divergent channels). ● For internal, sociocultural themes, use the primary channels, possibly the luo (connecting channels).

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For survival, competition, or premonitory dreams, use mainly the extraordinary vessels as well as the jing bie.

Modern Dream Theories in Relation to Chinese Traditional Concepts As we saw in Chapter 1, dreaming is considered to be indispensable to mental health. Dreams mostly occur during rapid eye movement (REM) sleep, and we dream for about 2 hours each night. During a normal life span, that represents a total of about 6 years of dreaming time. Historically, dream significance was established in the Chinese medical tradition as early as 100 BCE. In the West, although “dream interpretation” was taken up as part of psychoanalysis at the end of the 19th century, it still remains on the fringes of the modern medical world. Sigmund Freud (1856–1939) considered dreams to be symbolic expressions of frustrated desires that had been relegated to the unconscious mind): Dreams are the royal road to the unconscious. Sigmund Freud In his work The Interpretation of Dreams (Freud, 1994), Freud revolutionized the study of dreams. He believed that, in order to be able to live in a society, we have a tendency to hold back our urges and to repress our impulses. One way in which these impulses are released is through our dreams, often in symbolic language. Freud divided the mind into three parts: ● The Id, which is centered around primal impulses, pleasures, desires, unchecked urges, and wish fulfillment ● The Ego, which is the conscious, rational, moral, and self-aware aspect of the mind ● The Superego, the Id’s censor, which is also responsible for enforcing the Ego’s moral codes. These three aspects of the mind can be very loosely equated with three concepts in Chinese medicine: ● Hun roughly equates with the Id, the primal impulses.

● ●

Yi (thought) roughly equates with the Ego, the social and moral order. Shen roughly equates with the Superego, which is in charge of maintaining internal and external balance.

Carl Gustav Jung (1875–1961), although a follower of Freud, was equally influenced by the psychologist Alfred Adler as well as Greek philosophers such as Heraclitis. According to Jung’s theory of dreaming, the psyche regulates itself by means of a process of compensation. When there is an imbalance between the conscious and unconscious minds, the result is a fragmentation of the personality as well as neurosis or psychosis. Jung believed that the unconscious communicates with the conscious mind through dream imagery. Unlike Freud, though, he did not agree with using “free association” as a means of interpreting dreams. For Jung, the psyche attempts to right itself by providing possible solutions to the problem through dreams of an opposite nature (process of compensation). He further believed that the unconscious is a “rich vein” of creativity and the source of all genius. Jung divided the unconscious into a more superficial “personal unconscious” and a deeper “collective unconscious.” The former includes personal experiences that have been forgotten or repressed, and the latter includes the primordial, racial, ethnic, cultural, and familial collective unconscious (Fig. 5.1). The role of hun and po in the creation of behavioral and somatic gui (ghost, also called unnamed entity), were explored in Chapter 2. Many aspects of Jung’s collective unconscious are suggestive of the hun, in the form of images, symbols, and myths, or of the po, as expressed by instincts, mainly of protection. From the classical Chinese perspective, one of the functions of the hun is to release retained emotions through dream imagery. Although dream interpretation constitutes an important element of psychoanalysis, it is only very recently that medical science has demonstrated the relation between moods and emotions and the body on one side, and the impact of visual imagery on the body’s chemistry on the other. Mapping of brain activity during dreaming (Hobson and McCarley 1977) has shown activity in the right hypothalamus, which integrates the sensoryperceptual, emotional, and cognitive functions of the mind with the biology of the body. In other

Modern Dream Theories in Relation to Chinese Traditional Concepts

Consciousness The self Ego, persona Self-image Personal unconscious Subconscious memories/repressed emotions Collective unconscious Primordial/anima, animus Ethnic, racial/familial archetypes

Shen

Fig. 5.1 Jungian image of the stratified human psyche and its parallel with the Chinese concept of the shen.

Yi

Hun–po

Hun–po–zhi

words, parts of the dreaming brain experience the dream images as real and respond to these images by secreting the appropriate neurotransmitters. In 1980, Candace Pert, a biophysics and physiology researcher, confirmed an intricate biochemical communication network between the body and the mind, specifically the neural, endocrine, and immune processes. She discovered neuropeptide receptors on the smallest of cells, including immune cells. These neuropeptides, which act as molecular messengers, connect the mind and the body, which explains the action of emotions on the body (Pert 1999). There are numerous neurohumoral theories about dreaming, briefly explored in Chapter 1, but personally, I do not believe that any single neurohumoral theory can explain all the different kinds of dreams that we may experience during our lifetime. By integrating the ancient Chinese concepts about dreams with modern neurohumoral theories and the great contribution of the psychoanalytic schools, I would instead like to attempt a different classification of dreams (Table 5.1).

Developmental Dreams These dreams help the development of the brain, the body, and the psyche. This could explain the fact that babies spend over 50% of their sleep time in dreaming. During this type of dreaming, new ideas are experimented with by the mind, and probably new synaptic connections are established in the brain in preparation for learning new skills.

Babies are known to smile in their dreams before they smile in waking life. Several neurohumoral theories could support this group of dreams: The ontogenesis theory of Marks et al. (1995) concerns the development of the brain that would occur during neonatal REM sleep. Oneiric Darwinism, instigated by Blechner (2001), suggests that dreams create new ideas through the generation of random thought mutations. Some may be rejected by the mind as useless, while others may be seen as valuable and be retained. Emotional selection theory, as proposed by Coutts (2008), suggests that dreams function to test and select mental schema. Similarly, Adler (see Stein 2006) suggested that dreams are often emotional preparations for solving problems. This category of dreaming could correspond to the Daoist “questioning reality and developing imagination” type of dreams.

Interacting Dreams This would constitute the largest portion of dreaming, involving the impact of the world on the dreamer. It includes three aspects: the impact the outer world has on the individual (random dreams); the storage of memories and the learning process; and how the individual attempts to deal with these external influences (releasing), and the body tries to correct the negative impacts (healing):

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Processing the world: random thoughts and dreams of recent events reorganized into a new scenario, as proposed by Hobson and McCarley (1977) in their activation synthesis theory. Memory and learning: storing information for later use, a function supported by many neurohumoral theories: – Memory consolidation theory (Stickgold et al. 2001, Payne and Nadel 2004) proposes that dreams are involved in the linking and consolidation of semantic memories. – Excitations of long-term memory (Tarnow 2003) suggests that dreams are ever-present excitations of long-term memory, even occurring during waking life (as in daydreaming). – Continual-activation theory (Zhang 2004, 2005) proposes that the function of sleep is to process, encode, and transfer the data from the temporary memory to the longterm memory. Self-preservation and self-healing dreams: to help process daily events, release unexpressed feelings, and correct the damage caused by traumatic experiences. In Chinese medicine, this would also include the release of residual pathogenic factors.

Some neurohumoral theories support this type of dream: ● Reverse learning theory (Crick and Mitchison 1983): proposes dreams for removing junk, that is, the unnecessary memories and connections from the day. ● Releasing dreams, proposed by Ferenczi (1927) and elaborated by Vedfelt (2002): considers that dreams allow the repressed parts of the mind to be satisfied through fantasy. Freud suggested that bad dreams let the brain learn to gain control over distressing emotions (Cartwright 1993). For Jung (1934, 1974, 2002), dreams might compensate for one-sided attitudes held in waking consciousness. ● Integrating dreams theory (Hartmann 1995): dreams function as psychotherapy. ● Fulfillment theory (Griffin and Tyrell 2003, 2007): demonstrates that dreaming metaphorically completes patterns of emotional expectation in the autonomic nervous system and lowers stress levels. ● Mood regulating theory (Kramer 1993): pro-

●

poses dreams to have a corrective function with reference to mood. Psychosomatic theory (Tsai 1995): proposes that dreams could affect mind–body interaction by simulating the sensory signals to drive the autonomous nerves referred to as “repair nerves.” Maybe the discoveries of Pert (1999) (see p. 95) support the psychosomatic theory.

In general, these types of dreaming correspond to the Daoist “releasing dreams.” In these “clearing” dreams, certain residual pathogens are released, either external pathogenic factors/xie qi, as analysed in the Nei Jing and the Ling Shu (see below), or especially internal pathogens, which are created by the unexpressed emotions. The latter belief approaches that of the psychoanalytic schools discussed above.

Transformational Dreams These are dreams in relation to our life curriculum, through which we learn and evolve. Based on the Daoist belief that our ming is established at the moment of conception, this life curriculum will unfold itself through the shape that our lives take and the events that we encounter. In the West, no neurohumoral theories have been proposed for this type of dream. The Daoist tradition classifies these dreams as the “great awakening.” This third category could include the following: ● Premonitory dreams, in which future events reveal themselves in symbolic form ● Processing dreams, in which the dreamer works out certain life issues. In the Daoist tradition, the conscious processing of the life curriculum acts as a gateway to awakening. ● Lucid dreaming, which is the aim and purpose of spiritual seekers, be this in the ancient Hindu, Buddhist, or Daoist traditions, or in more contemporary teachings, such as propagated by G.I. Gurdjieff (Gurdjieff 1950). By becoming conscious during our dreams, we first take control over the flow of our lives and ultimately awaken completely from the illusion of what we consider to be this reality. The dreamer thus becomes aware of the illusory nature of dreams and of life and can hence attain free will.

Modern Dream Theories in Relation to Chinese Traditional Concepts

Table 5.1 Proposed classification for dream categories Proposed classification

Western neurohumoral theories

Developmental dreams: dreams that help the development of the brain, the body, and the psyche

●

Dreams that question Ontogenesis (Marks et al. 1995): concerns the development of the brain that would occur during neonatal REM sleep. This could explain reality, developing the fact that babies spend over 50% of their sleep time in dreaming imagination

●

Oneiric Darwinism (Blechner 2001) or random thought mutations: dreams create new ideas through the generation of random thought mutations. Some may be rejected by the mind as useless; others may be seen as valuable and be retained

●

Emotional selection theory (Coutts 2008): for testing and selecting mental schema. Adler (Stein 2006) similarly suggested that dreams are often emotional preparations for solving problems

● Interacting dreams: dreams that help to process daily events, consolidate memory, and release suppressed emotions or pathogenic factors (self-preservation and self-healing)

Transformational dreams: premonitory dreams, processing dreams, and lucid dreaming REM, rapid eye movement.

Activation synthesis theory (Hobson and McCarley 1977): the sensory images and sounds are the result of random firing of neurons in the cerebral cortex during REM sleep, reorganized by the forebrain into a coherent story in which the person is most often a participant. Solms (2000) challenges this theory by suggesting that dreams are generated in the forebrain, and that REM sleep and dreaming are not directly related, but a function of many complex brain structures, thus validating Freudian dream theory

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Reverse learning theory (Crick and Mitchison 1983): proposes dreams act to remove junk, that is, the unnecessary memories and connections from the day

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Releasing dreams (Ferenczi 1927, Vedfelt 2002): allow the repressed parts of the mind to be satisfied through fantasy. Freud suggested that bad dreams let the brain learn to gain control over distressing emotions (Cartwright 1993). For Jung, dreams might compensate for one-sided attitudes held in waking consciousness (Jung 1934, 1974, 2002).

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Mood-regulating theory (Kramer 1993): in which dreams correct, regulate, or influence mood

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Integrating dreams (Hartmann 1995): dreams function as psychotherapy

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Psychosomatic theory (Tsai 1995): dreams can affect mind–body interaction by simulating the sensory signals to drive the descending pathway of autonomous nerves, referred to as “repair nerves”

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Memory consolidation theory (Stickgold et al. 2001, Payne and Nadel 2004): linking and consolidation of semantic memories

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Excitations of long-term memory (Tarnow 2003): suggests that dreams are ever-present excitations of long-term memory, even during waking life (as in daydreaming)

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Continual activation theory (Zhang 2004, 2005): proposes that the function of sleep is to process, encode, and transfer the data from the temporary memory to the long-term memory

●

Fulfillment theory (Griffin and Tyrell 2003, 2007): dreaming metaphorically completes patterns of emotional expectation in the autonomic nervous system and lowers stress levels

No Western theories have been proposed

Daoist categories of dreams

Allowing the opposite belief to occur, or also to express what is suppressed

Great awakening (life is like a dream), dreams carry a portal to awakening

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Dreams as Reality, or Life as a Dream Although science as yet has no clear theory regarding the mechanisms involved in and the purpose of dreaming, there is one popular consensus, namely that dreams are not reality. The Oxford Dictionary defines reality as “the state of things as they actually exist.” In its widest sense, this includes everything that is, whether or not it is observable or comprehensible. On a much broader and more subjective level, private experiences and the personal interpretation of events shape reality as seen by one individual. This is called phenomenological reality. Historically, reality was based on facts. A fact is an observed phenomenon in the natural world that is perceived as an elemental principle. It is rarely one that can be subject to personal interpretation. And yet for centuries, “facts“ such as that the earth is flat or that the sun is at the center of the universe dominated man’s perceptions and definitions of what is real. Today, the most pertinent of these facts could be said to be the “solid” nature of matter. Even though science explains that more than 99% of matter comprises empty space, our age-old conditioning does not allow us to perceive it other than solid. To quote from a review of A. Zee’s book Quantum Field Theory in a Nutshell: It is often deeper to know why something is true rather than to have a proof that it is true. Zee 2010 In quantum physics, Heisenberg’s Uncertainty Principle led the nuclear physicist Amit Goswami to assume that no reality exists independently of our own consciousness as observer. Whether this is true or not, this line of thinking brings us back to the ancient philosophical systems such as Buddhism, which state that life, as we conceive it, is but an illusion. This illusion is created by the mind, which perceives the natural phenomena and interprets them according to our sociocultural conditioning. This social framework gives a semblance of coherence and maintains mental sanity. The dream world, on the other hand, offers windows of escape into other possible dimensions, in which other realities are experienced, allowing those possibilities to slowly seep into the current

“objective” reality. Leonardo Da Vinci and Jules Verne are good examples of visionaries who imagined and described the future with uncanny accuracy. The question here is whether their dreams were visions of the future, or whether they were a means of offering new possibilities or beliefs that were waiting to be materialized. In a sense, what man imagines, man can create. The debate about the mind’s capacity to create or at least influence matter is the central topic of metaphysics. In medicine, previously controversial phenomena such as the placebo and nocebo effects are today considered to be facts. It is now clear that the human mind has the capacity to create a disease or to miraculously heal it, although we do not yet know how to duplicate these conditions. This could be considered to be the aspect which most spiritual teachers emphasize, that is, that we create our own reality. Most religions, although they believe in a supreme creator, make humans responsible for their actions and the consequences of those actions. In the Western tradition, the relation between the intellect and the intuitive, the human and the divine (called “noetic theory”), was explored by ancient Greek philosophers such as Plato and Aristotle, and later by Christian and Muslim mystics. In China, the three main philosophical systems—Daoism, Confucianism, and Buddhism— support a similar vision of reality, in which life is considered to be a dream. Great emphasis is therefore put on understanding dreams in order to better realize the illusory nature of life. We are living in very exciting times. Science now has the possibility to verify ancient concepts and beliefs, in particular exploring the uncharted limits of the mind’s potentials. This could even allow mankind to take over the reins of its own destiny. After all, is this not the message and the teaching of all past visionaries, teachers, and prophets?: I have to destroy the old structures and build a new kingdom, powerful and splendid. Bhagavad-Gita

The Significance of Dreams in the Chinese Tradition

The Significance of Dreams in the Chinese Tradition In the Su Wen, Chapter 17, paragraph 7, Qi Bo explains the localization of disease and the importance of taking the pulses and observing the appearance and the colors in Chinese medicine diagnosis (face, tongue, eyes, body, urine, stool, etc.), as well as the analysis of dreams. Qi Bo further associates certain dream topics to specific disharmony patterns:

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and the wei qi, emerging with the hun and the po, and producing dream-disturbed sleep. When the yin is in repletion (pathogenic qi is in the ying level), the person dreams of wading fearfully in the Great Water (da shui). When the yang is replete (xie qi is in the wei level), the person dreams of Great Fire (da hua) and burning. When both yin and yang are in repletion, one dreams of massacres. When the upper regions are in repletion, one dreams of flying. When the lower parts are replete, there are dreams of falling. Extreme hunger produces dreams of possession; in a state of satiety, the person dreams of donation.

Dreams of fire

Signify yang repletion

Dreams of a large body of water

Signify yin repletion

Dreams of mutual destruction

Signify yin and yang repletion

Dreams of flying

Signify repletion above

Dreams of falling

Signify repletion below

Dreams of crowded places

Relate to short gu (worms)

Anger and irritability

Liver qi repletion

Dreams of fights, arguments

Relate to long gu (worms)

Anxiety, fear, crying, flying

Lung qi repletion

Dreams of anger

Relate to the liver

Laughter, fear, awe

Heart qi repletion

Dreams of crying, sorrow

Relate to the lungs

Music, singing, or a heavy body

Spleen qi repletion

Pelvis, sexual dreams, loose spine

Kidney qi repletion

In Chapter 80 of the Su Wen, the dream topics are associated with more specific zang fu dysfunctions, and more precisely the state of vacuity/deficiency of the zang yin organs:

●

The dreams listed below are specifically related to zang fu repletion (Table 5.2):

In the second paragraph of Chapter 43 of the Ling Shu, the significance of a dream is related to zang fu vacuity (Table 5.2) and xie qi:

Dreams of flowers, fragrance

Signify liver vacuity

Dreams of white objects, bloody battles

Signify lung vacuity

Mountains, impressive heights, mounds, fire, oppressive smoke

Qi vacuity with xie qi in the heart

Dreams of raging fires, explosions

Signify heart vacuity

Flying, losing one’s footing, strange metallic or golden objects

Qi vacuity with xie qi in the lung

Dreams of starvation, construction, buildings

Signify spleen vacuity

Trees, forest, plants, mountains

Qi vacuity with xie qi in the liver

Dreams of drowning, swimming

Signify kidney vacuity

Ruins, mounds, swamps, fog, wind, rain

Qi vacuity with xie qi in the spleen

Precipice, looking down into empty space, immersion or drowning in water

Qi vacuity with xie qi in the kidney

Wandering, traveling

Qi vacuity with xie qi in the bladder

Large meals of food and drink

Qi vacuity with xie qi in the stomach

Foreign lands and rice fields

Qi vacuity with xie qi in the large intestine

Chapter 43 of the Ling Shu (Zan Xie Fa Meng, or “Repletion of Evil [Pathogenic] Qi and the Manifestation of Dreams”) is entirely dedicated to dreams. In this chapter, Qi Bo gives the following explanations: ● When the xie qi penetrates the body, it does not yet have a fixed location. It will replete the zang fu without residing in them, following the ying

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Crowded places, meeting of many Qi vacuity with xie qi in people, busy roads, crowded cross- the small intestine roads Arguments, struggling with choices Qi vacuity with xie qi in and decisions; being emptied out, the gallbladder dried out; implication of self-destruction, suicide

Qi Bo further indicates a supplementing method for the above conditions. The following dreams indicate the physical location of the xie qi: Sexual dreams, relations

Xie qi in the genital region

Beheading, sensation of being leaderless

Xie qi in the neck area

Incapacity to walk, walking in circles; dwelling in a cave

Xie qi in the lower limbs

Rites, prayer, prostration

Xie qi in the upper and lower limbs

Loss of urine and stool

Xie qi in the bladder and rectum

Common Dream Interpretations and Therapeutic Strategies Based on the Discussions and Commentaries on Sleep and Dreams by Master Yuen

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To take account of influences from shamanistic (oracle bones), philosophical (Confucianism), and religious (Daoism and Buddhism) beliefs To evaluate not just the dream, but also the state upon awakening from the dream To correlate similarities between the dream themes and events and experiences involving stress, shock, and trauma

The three methods of dream analysis (san fa) include an analysis of: ● The dream itself ● The state of the person upon awakening ● The awake state correlations: the factors that influence dreams (san yin), that is: – Environmental factors – Cultural factors – Constitutional factors According to Master Yuen, there are five categories of dreams that should not be interpreted: ● Dreams after going to sleep in a stressed or emotional state ● Dreams after going to sleep with distressing thoughts ● Dreams with a great sense of danger (as interpretation may reinforce the sense of danger) ● Interrupted dreams (as there is no sense of conclusion) ● Partially forgotten dreams

According to Master Yuen, it is important in dream interpretation:

Table 5.2 Dreams and their significance in relation to the zang fu Zang

Heart

Spleen

Lung

Kidney

Liver

Shi/excess/ repletion

Laughter, fear, awe

Music, singing, a heavy body

Anxiety, fear, crying, flying

Loose spine, sexual dreams

Anger, irritability

Xu/deficiency/ vacuity

Raging fires, Starvation, White or metal oppressive smoke, building, ruins, objects, battles, explosions mounds, swamps, precipices fog

Drowning, swimming

Flowers, plants, trees, fragrance, mountains

Fu

Small intestine

Stomach

Large intestine

Bladder

Gallbladder

Xu/deficiency/ vacuity

Crowds, busy roads

Large meals

Foreign lands, rice fields

Wandering, travel Arguments, decisions, self-destruction

Common Dream Interpretations

Dreams of Fear/Danger/Threat = Kidneys General Concepts Dreams of fear, danger, and threat represent life as a struggle for survival. This idea is intimately related to the ren mai and du mai. The ren mai in particular, with its need for bonding or to be loved, manifests in dreams of danger in which there is no one to help or to support. It can also manifest in dreams of abandonment. In such cases, use lie que LU-7 for ren mai, or hou xi SI-3 for du mai. Dreams with feelings of being “frozen” or the inability to avert the threat can be associated with the jing bie. In such cases, use wei zhong BL-40, yin gu KI-10, and tian zhu BL-10. Consider the size of objects, people, and animals and the color of the dreams. Black-and-white dreams denote a kidney pattern, whereas dreaming in color indicates a heart pattern, usually heart blood vacuity. Take note of what or who is the predator. If it is a known person, this relates to blood, indicating the use of chong mai. If an unknown individual, a stranger, a ghost, or a villain is involved, then phlegm is the cause, in which case ren mai or yin qiao mai (motility or stepping vessels) are indicated. Are there any threatening objects, such as a knife, teeth, or claws? If so, this indicates xie qi, hence the use of the jing-well points. Ask the dreamer about the sensation experienced upon awakening. Did the dreamer feel anxiety, dread, a feeling of being startled, hatred (often of someone they know), or a sense of eeriness around them? This indicates the use of gui points, such as yin bai SP-1 or jian shi PC-5.

Other General Points Indicated in Fear Dreams ●

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Yong quan KI-1 stabilizes the shen, and is used for fright wind, very visual dreams, poor memory, that is, poor recall of events, loss of appetite, loss of desire for life or food, and “running piglet” syndrome (panic attacks). Tai xi KI-3 is used where there is a sense of lack of resources in the dream (lack of yin), for dreams related to the ears, for auditory dreams, for dreams of the voice box and asthma, and for dreams of shortness of breath. Both KI-1 and KI-3 promote urination and defecation (constipation could be causing the nightmares).

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Zhao hai KI-6 clears heat and calms the shen when bled. It is also indicated in nightmares in the premenstrual phase or prior to labor due to blood stasis.

Common Traditional Chinese Medicine Kidney Patterns Causing Fear Dreams Liver Blood Not Nourishing Kidney Jing This is common among children. It can also manifest physically as bed-wetting. There are bluish lines on yin tang area EX-HN-3, indicating liver blood vacuity. Use yong quan KI-1, tai xi KI-3, zhao hai KI-6, tai chong LR-3, qu quan LR-8 (blood): ● This pattern will produce dreams of being attacked by a person, animal, monster, or object, with the intent to harm or kill the dreamer. ● There will be dreams of feeling threatened and not “knowing” what to do, with no sense of “direction” or control. ● The sense of loss of control involves the heart (liver blood not nourishing the heart). ● In self-driven anger resulting in dreams with themes of danger or violence toward the self, use da dun LR-1, yong quan KI-1, tai xi KI-3, zhao hai KI-6. Kidneys Not Grasping Lung Qi Here the dreams do not involve an attacker, but instead injury, harm, threat, or death from an accident or illness. These dreams often occur during the onset of an illness in oneself or those around one, and are associated with one’s inability to accept the disease, with fears of the illness. Lung qi remains on the exterior to protect, defend, and guard with a sense of hypervigilance (as in autoimmune diseases). Consider the individual in the dream that is ill (child, elderly, middle-aged, the transitions of life as in cycles of 7 and 8 years), as they may represent the dreamer’s inability to accept a certain stage in their life. It is said that po holds on to the past (the person is unable to breathe in). These cycles concern the yin and yang wei mai. A particular trauma or difficulty that has occurred at a certain period of life will bring about a sense of lack of completion of that stage, which manifests itself in dreams. There might be asthmatic manifestations upon waking.

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The yin wei mai deals with these life passages. The yin wei points represent these stages: zhu bin KI-9 represents a new beginning; the transitional stages are represented by fu she SP-13, da heng SP15, and fu ai SP-16; and the ending, with its sense of completion, is signified by qi men LR-14. Kidney Qi or Yang Vacuity Dreams of death, often from neglect, withdrawal, suffocation, smoldering fires, or confinement occur. Often there is also some manifestation of sleep-walking (an attempt to break through the confinement). In such cases, use dai mai (girdling vessel) together with shen shu BL-23, zhi shi BL-52 both with moxa. Such dreams can involve an inability to feel, reawakened, renewed or restored (so the person is very tired upon waking).

For example, for a nightmare involving fear and loss (kidney) and a natural calamity such as a blizzard (water), use yong quan KI-1 with bu lang KI22. ● Dreams are often influenced by severe environmental factors challenging the yuan qi, hence the fear. This may also involve the kidney and bladder jing bie, with their pathways looping around the abdomen and the chest. In this case, the dream pattern will be recurring, and wei zhong BL-40, yin gu KI-10, and tian zhu BL-10 should be added. ● Nightmares are often associated with intense and overwhelming emotions, or pain and suffering. Consider what is at risk, and whether an escape route or protection is available. If there are possible solutions, help, or escape in the dream, this denotes that sufficient kidney qi is still available.

Dreams of Home/Property/Territory/ Boundaries/Valuables = Spleen

Heart and Kidneys Not Harmonized (San Jiao) Dreams of calamities, wars, battles, bombs, explosions, famine, nuclear explosions, disasters, annihilation, or chaos from natural causes occur. These dreams are interpreted in relation to the five types of pathogenic factor: Dreams of tornados, typhoons

General Concepts ●

Wind

Dreams of forest fires, volcanic eruptions

Fire

Dreams of flooding, tidal waves, tsunami

Dampness

Dreams of drought

Dryness

Dreams of blizzards

Cold

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These dreams involve the values that we attach to our possessions, treasures, or property. The destruction of these possessions is from either fire (which evokes stomach heat), water (evoking spleen dampness), or other natural causes (but not as severe as the disasters cited in the fear dreams, as in the case of the heart and kidney not in harmony). These dreams may involve the kidneys when the dreamer is attempting to save others or deal with fear involving escape or destruction. Consider what has been destroyed, stolen, or lost.

Here, the use of the kidney points on the chest as described in the Su Wen are indicated. These chest shu points are all situated on the chong mai:

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KI-27

Shu fu

General shu point

General Points for Spleen Patterns

KI-26

Yu zhong

Metal

For dryness

KI-25

Shen cang

Fire

For heat and fire

KI-24

Ling shu

Wood

For wind

KI-23

Shen feng

Earth

For dampness

KI-22

Bu lang

Water

For cold

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Yin bai SP-1 stabilizes the shen, is used for excessive dreaming (with li dui ST-45), retreating from the world, melancholia, grief, frequent sighing, or a sensation of something sitting on one’s chest. Da du SP-2 is used for thought associations (one thought leading to another), a racing mind or heart, obsessive thinking, and excessive dreaming, and it resuscitates yang.

Common Dream Interpretations

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Gong sun SP-4 deals with judgment and values, and value given to property. It also rectifies qi in relation to guilt or praise. San yin jiao SP-6 is the harmonization point (between the spleen, liver, and kidney), it regulates the middle burner, regulates the qi, blood, and jing, expels wind–dampness, and is used for anuria and nocturia.

Common Traditional Chinese Medicine Spleen Patterns Causing Loss of Property Dreams

Spleen Qi Sinking ●

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Spleen Qi Vacuity ●

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Dreams involving the inability to maintain and secure one’s boundaries, property, or possessions, suggesting the concepts of value, worth, and ownership, indicate the involvement of the postnatal qi, hence the use of zhong wan CV-12. Consider what is destroying the property or who is stealing from you. A family member indicates the involvement of the kidney (water insulting earth); a stranger involves the liver (wood destroying the earth). If the destruction is caused by a calamity, then fire indicates stomach heat, water indicates spleen dampness, drought stomach yin vacuity, and a blizzard spleen yang vacuity. Note the size or condition of the object. The size indicates the amount of phlegm; the age signifies chronic phlegm. Also, if a certain room in a house has been damaged or destroyed, there is a correlation between the room and the body. In these cases, supplement the yuan point of the related organ/room. Is the age of the object a reflection of the dreamer’s age (cycles of 7 or 8 years)? This will indicate the addition of yin wei mai points

Dreams of a destroyed kitchen

Signifies the stomach

Dreams of a destroyed living room

Signifies the spleen

Dreams of a destroyed bathroom

Indicates the bladder

Dreams of a destroyed bedroom

Indicates the kidney

Dreams of a destroyed library

Signifies the spleen

Dreams of a destroyed garden

Indicates the liver

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This often occurs when first starting to fall asleep, and produces an anxious rapid descent, or dreams of dropping. It can also follow a trauma from a major disappointment. Dreams of sinking and falling with no support or control, or after climbing to great heights, are quite common among the elderly. These dreams may originate from insecurities (kidney vacuity) or may indicate that a situation, such as health or finances, is changing for the worse. Consider whether the patient is afraid of heights, being in front or on top, being too close to the edge (liver overacting on the spleen), or being knocked off a position of grace or of power, and whether there is anything to cushion or to support the fall. If there is no support, there is kidney vacuity, in which case use di ji SP-8 and add ran gu KI-2. You may need to ask what is seeking attention, what is letting the person down, or what the dreamer is falling from: a mountain signifies the lung, a boat represents the kidney, a car signifies the liver, and so on. These dreams indicate the organ causing spleen qi sinking.

Spleen Vacuity with Dampness ●

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Dreams of drowning or being submerged, or of being buried in the ground due to being overwhelmed, denote excessive dampness. Dreams involving a sense of hopelessness and of being stuck, or of having a hard time staying up or afloat. also denote excessive dampness.

In such cases, use yin ling quan SP-9, moxa yin bai SP-1, da du SP-2, gong sun SP-4, san yin jiao SP-6, and yin ling quan SP-9.

Dreams of Control/Direction/Movement/ Navigation = Liver General Concepts ●

These dreams involve the malfunction or breakdown of a necessity or instrument, a weapon (for survival), a machine (for production or

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● ● ●

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communication, such as a telephone), or a device or tool (to complete a task), or in general anything that prevents the person from reaching their completion or final destination. Dreams may have themes resulting in an inability to provide a smooth flow or connection. Means of transport, for example bicycles, cars, carts, or horses, may be involved. There is a further analogy between the mechanical parts of the vehicle and the physical body. For example, the windows denote the eyes, the wheels signify the limbs, the engine is suggestive of the heart, the carburetor signifies the lung, and the cooling system signifies the triple burner. The notion of the ability to navigate, to steer, or to command (control of qi) and the ability to come to a halt, for example being able to brake, signifies liver controlling the spleen and stomach. Consider who is driving, and the size and condition of the vehicle. An old car signifies a longstanding blood stasis. Is the vehicle moving in the direction of choice or is it going the wrong way (counterflow qi)? What are the view and the landscape?

cate the stomach. In such cases, use the lower he (sea) points. Liver Blood Stasis ●

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Liver Blood Vacuity ●

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General Points for Liver Patterns ●

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Xing jian LR-2 regulates qi, clears heat, and deals with movement, resentment from taking on responsibility, and true heat with false cold (cold extremities with heat in the middle). Tai chong LR-3 is used for all liver patterns and areas (eyes, head, chest and flanks, genitals, medial legs).

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Common Traditional Chinese Medicine Liver Patterns Causing Control Dreams Liver Qi Stagnation

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Dreams may involve the failure of an instrument or something being jammed or stuck, causing a feeling of frustration. Consider the role and function of the tool, as it may correlate with a specific part of the body that is breaking down. For example, a toilet that does not flush represents the large intestine or bladder. A malfunctioning kitchen could indi-

There may be dreams of poor performance or preparation, of difficulty meeting a challenge, of missed opportunities, or of missed means of transport—such as a train, a plane, an elevator, a boat—that will allow one to reach a destination, all causing reactive frustration. Such dreams are frequent in adolescence or in the premenstrual phase. Consider what the performance relates to (work or school?). What is the role of the person in the dream? And who is “judging” the performance? Is time an issue? Consider what the opportunity, chance, connection, destination was, and the factors that prevented the patient from attaining the goal or getting somewhere. These dreams may stem from low self-confidence. For kidney yin vacuity resulting in liver blood vacuity, use qu quan LR-8.

Liver Yang Ascending ●

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Dreams involve an inability to get around, with no sense of direction, a lack of control, an obstacle along the way, or a vehicle about to crash or collapse. These dreams are common when individuals are physically or emotionally incapacitated. Use yin lian LR-11 and li gou LR-5.

Dreams involving excessive yang activity include those of running about, dancing, climbing, flying, and crowds. In such cases, use bai hui GV-20.

Dreams of Vulnerability/Exposure = Lungs General Concepts ●

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Dream themes involving the skin and clothing, lack of protection, or being naked or too exposed relate to the lung. These dreams can also involve being caught or exposed from hiding.

Common Dream Interpretations

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There may be feelings of being less “perfect” or “complete,” or perhaps overly protected or surrounded, or even feeling suffocated; skin conditions (being self-conscious of one’s looks) also appear in such dreams. Consider who is exposing the dreamer and who notices the “embarrassment” or “shame.” What are they exposing? Consider the setting or environment.

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result of the deceased person’s po visiting the dreamer, to help process some unfinished matters. This kind of dream corresponds to the lungs. Difficulty with someone’s death due to a violent death, non-acceptance, or guilt will often provoke these dreams. Gui can serve as “spirit guides” or the return of the deceased to inspire or command (due to their perceived authority).

General Points for Lung Patterns General Points for Phlegm Patterns ●

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Tian fu LU-3 for excess tearing from sadness, dizziness, stress asthma, ghost talk (talking to oneself) Yu ji LU-10 for heat in the lung, and blood heat with bleeding

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Common Traditional Chinese Medicine Lung Patterns Causing Vulnerability Dreams Exogenous Pathogenic Factors ●

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There may be vulnerability to nature or dreams of nature, and a personal aversion to or enjoyment of the scenery. Dreams of flowers and landscape often manifest change or metamorphosis toward “beauty.” In such cases, add he gu LI-4 to the general points tian fu LU-3 and yu ji LU-10.

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Lung Qi or Lung Yin Vacuity ●

For dreams of nakedness and being exposed with difficulty connecting with others, supplement chi ze LU-5 with moxa.

Shen men HT-7 quiets and calms the shen, and is used for poor memory, Alzheimer disease, withdrawal, vexation, agitation, and sleep-talking. Xi men PC-4 is used in an emergency. It quiets the shen, rectifies qi, and deals with guilt, fear, fright, sadness, melancholia, and claustrophobia. Nei guan PC-6 deals with guilt and shame. It rectifies qi, digestive issues with stasis, eating disorders, fright wind, convulsions, and poor memory. Da ling PC-7 quiets the shen, opens the chest, and deals with fear, grief, and overanxiety or laughter. According to Liu Wansu (1120–1200, founder of the “school of cooling”), to fully release an emotion there should be fluid discharge, such as crying.

Common Traditional Chinese Medicine Dream-Shock Patterns Causing Night Terrors Phlegm Harassing the Heart

Dreams of Night Terrors/Ghosts = Accumulation of Phlegm

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General Concepts ●

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Gui zha (ghost oppression) involves the sensation of a weight on the chest, which often feels like someone is sitting on top of the chest. This may block the production of qi (growth) and blood (space). The patient may dream of the deceased. In the Chinese tradition, this kind of dream is the

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This is associated with harassment from the deceased, which is often due to guilt (e. g., did you do all you could have, are you responsible for their death, were you there at their passing?). Rarely do we feel that a ghost will harm us unless we feel some responsibility for their death. At worst, the dream can provoke suicide (“join me”). Use feng long ST-40 for hot phlegm.

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Phlegm Misting the Mind ●

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This is associated more with a sense of unfinished business (perhaps due to the age of the dreamer), unfinished words, or warnings. It can be associated with a part of the dreamer’s own life that they have not been able to let go of, for example a child’s death, as well as abortion.

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The pattern often evolves around the inability to accept someone’s death, with working through grief. Use tian fu LU-3 for those who often wake up with puffy eyes and for the “floating ghost” (a sensation of something hovering around) (Table 5.3).

Table 5.3 Dream significance inspired by the Meng Zhan Yi Zhi (Analysis and Conclusion of Dreams), as commented on and complemented by Master J. Yuen Dream content

TCM patterns

Point selection

Nightmares: fear, danger, threat

Kidney qi or jing

KI-1, KI-3, KI-6

Being attacked, loss of control

Liver blood not nourishing the heart

Add: LR-8, HT-7

In children with enuresis

Liver blood not nourishing kidney jing

Add: LR-3, LR-8

Self-directed violence

Liver blood not nourishing jing

Add: LR-1

Harm from accident or illness

Kidney not grasping lung qi

Add: LU-5, KI-22

Death dreams

Kidney qi or kidney yang vacuity

Add: BL-23, BL-52, dai mai

Calamities, wars, explosions:

Heart and kidney not in harmony

Add: KI-27

— Tornado, typhoon

— Wind (wood)

Add: KI-24

— Fires, volcanic eruptions

— Fire or heat (fire)

Add: KI-25

— Flooding, tidal waves

— Dampness (earth)

Add: KI-23

— Drought

— Dryness (metal)

Add: KI-26

— Blizzards, cold

— Cold (water)

Add: KI-22

Recurring dreams of fear

Kidney and bladder jing bie

Add: BL-40, KI-10, BL-10

Loss: property, boundaries, valuables

Spleen qi vacuity with dampness

SP-1, SP-2, SP-4, SP-6

Destruction, loss of possessions

Spleen qi vacuity

Add: CV-12

Falling or sinking

Spleen qi sinking

Add: GV-20

Falling with no support

Spleen qi sinking with kidney qi vacuity

Add: SP-8, KI-2

Drowning or being buried

Spleen qi vacuity with dampness

Add: SP-9

Control: direction, movement

Liver qi stasis or counterflow

LR-2, LR-3

Failure of a tool, blockage

Liver qi stasis

Add: LR-14

Obstacles, no sense of direction

Liver blood stasis

Add: LR-11, LR-5

Missed opportunity, bad performance

Liver blood vacuity

Add: LR-8

Excessive activity, crowds

Liver yang rising

Add: GV-20

Vulnerability: exposure, shame

Lung qi or lung yin

LU-3, LU-10

Nature, vulnerable to the elements

Lung qi vacuity with xie qi invasion

Add: LI-4

Nakedness, exposure

Lung qi and lung yin vacuity

Add: LU-5

Night terrors: ghost dreams

Accumulation of phlegm

HT-7, PC -4, PC-6, PC-7

Harassed by the dead, guilt

Phlegm harassing the heart

Add: ST-40

Unfinished business, nonacceptance

Phlegm misting the mind

Add: LU-3

The Importance of Reintegrating Dream Interpretation into Chinese Medicine

The Importance of Reintegrating Dream Interpretation into Chinese Medicine Over the past century, Chinese medicine has been progressively copying the Western scientific materialistic model, which has resulted in a brand of Chinese medicine misleadingly called “Traditional Chinese Medicine” or “TCM,” a term that was coined in the late 1940s (Taylor 2005). During the Cultural Revolution, all references to the psychospiritual dimensions of the human being were discarded as “old superstitions.” And yet the ancient texts describe the interaction of the emotions and the body. The Ling Shu confirms that shen and qi rule and shape matter: Heaven comes first, Earth is second. Ling Shu The arrival of Buddhism in China further reinforced the concept that the source of all suffering was to be found in the mind, specifically in the manner in which we perceive reality: We are shaped by our thoughts, we become what we think. The Buddha In the 12th century, Chen Yan clearly classified the causative factors of disease into three categories (san yin), introducing the two opposites of climatic and physical causes, and internal or emotional factors (Fruehauf 2004). In an excellent article entitled “All Disease Comes From the Heart,” Heiner Fruehauf elaborates on the “Pivotal role of the emotions in Classical Chinese Medicine” (Fruehauf 2004). He further underlines the Nei Jing quote regarding the “superior physician,” who treats disease when it has not yet structurally manifested, whereas an “inferior physician” has to treat disorders that have already progressed to the physical body (Su Wen, Chapters 2 and 26; Ling Shu, Chapter 55). Chinese medicine has emphasized the notion of “the mind and the emotions affecting the body,” something Western medicine has termed “psychosomatics.” Dreams have been used in Chinese medicine not only to analyze zang fu disharmony patterns, as in the Su Wen and Ling Shu, but also for explor-

ing psycho-emotional disturbances, as in the Meng Zhan Yi Zhi. In Chapter 2, we explored the Chinese notion of how the shen, through the auspices of the hun, releases retained pathogenic energies through dreams. Western psychology, mainly owing to the pioneering work of Freud and Jung, offers us powerful tools for analyzing dreams and understanding the underlying and suppressed emotions. If the spirit is at peace, the heart is in harmony; when the heart is in harmony, the body is whole; if the spirit becomes aggravated, the heart wavers, and when the heart wavers, the spirit becomes injured; if one seeks to heal the physical body, therefore, one needs to regulate the spirit first. Liu Zhou, 6th century philosopher In this manner, a therapist aspiring to become a superior physician has to treat the disease at its most subtle level, that is, the level of the shen, the mental and emotional dimensions. There are two possible approaches to treating the internal causes of diseases (the emotional patterns): shen and qi. Based on the principle that the shen leads qi, and qi affects the shen, one can better understand the first approach, the emphasis that Confucianism, Daoism and Buddhism place on mental discipline and the “cultivation of the self.” The second approach, that is, modulating qi to affect the shen, is the domain of acupuncture. In Chapter 3, we explored acupuncture points and some strategies for dealing with emotional issues. The Chinese medical tradition is full of shamanic practices, as reflected in the names of many acupuncture points containing shen, ling (soul), or gui (see Appendix 1). Sun Si Miao even described a protocol for releasing ghosts and treating possessions, called “The 13 Ghost Points” (see Appendix 1) It is worth mentioning a modern-day protocol attributed to Worsley called the “Seven Dragons,” which has two variants, for internal or external demons. The origin of these point combinations is unknown, but they have the benefit of some 40 years of clinical experimentation (see Appendix 1, p. 129). In summary: ● Based on the rich Chinese medical tradition (explored above) and the contributions of mod-

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●

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ern psychoanalytic schools, it could be deducted that dreams offer an excellent doorway to the hidden dimensions of a disease process. Chinese medicine has given a central role to the emotions in the genesis of disease (see above). In Chapter 2, we have explored the impact of emotions on the shen, especially when they are not expressed. Also the role the hun plays in helping to liberate these emotional pathogenic factors through dreams. Therefore, the dream language can be an invaluable help for the patient in order to get to grips with this suppressed part of the psyche, as it has been suggested by the psychoanalytic schools (Jung 1934, 1974, 2002; Garfield 1988; Faraday 1990; Freud 1994; Sullivan 1998; Barasch 2000). Many psycho-emotional patterns have deeper roots, and go back to early physical or psychological trauma.

It is very important for patients to be able to participate in their healing process by actively engaging in exploring the problem with their therapist. A Daoist saying expresses this idea: To treat a problem you have to first name it, then own it. The therapist can use dream symbolism, especially how the person felt during or after the dream, to identify the main message or issue. Science has established that dreams produce certain biophysical changes in the body (see p. 95) and that the same changes could result from appropriate visualization techniques (see Appendix 2). The West offers modern psychotherapeutic approaches, including many that use dream work and guided visualizations. In combination with the ancient treasures of classical Chinese medicine and acupuncture, they could provide a most formidable healing technique (see Appendix 2).

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Clinical Evaluation

The following study* was designed almost 20 years ago and was funded by the Swiss National Science Foundation. Today, if I had to redo the study, I would certainly not propose the same structure. At the time, a comparative statistical study of two groups—one treated with individualized acupuncture and the other receiving sham treatments—was considered scientifically relevant. But today, placebo effects are well acknowledged, and it is an established fact that the therapist’s expectations have a quantifiable effect on the outcome of the therapy. As we cannot propose a double-blind study involving acupuncture, the methodology used in the study is somehow now obsolete. Further, proposing only three to five sessions of treatment was highly insufficient for the patients who were willing to undergo the therapy, as most had suffered from insomnia for between 15 and 20 years. With hindsight, I think it would have been more appropriate to conduct a study simply on the effects of acupuncture on insomnia on a much larger population, and to later make a comparison with results obtained using other methods. Most clinical trials and studies have been based on a subjective evaluation of sleep. Objective sleep analysis using polysomnography has demonstrated an interesting point, namely that there is quite frequently a discrepancy between the objective and subjective evaluations of sleep. The validity of this finding was confirmed by many of the patients who were analyzed in the following study. This discrepancy stresses the importance of evaluating sleep not only subjectively, but also objectively.

Clinical Study on Acupuncture and Insomnia In order to assess the effectiveness of acupuncture using the diagnostic principles outlined above, a research project was set up involving 40 patients suffering from different types of primary insomnia. In this study, the treatment was limited to three to five sessions within 4 weeks. Obviously, much longer treatment is necessary in the case of chronic and resistant insomnia. After taking an in-depth patient history, the first session consisted of treating the affected “synchronizer.” In most cases, the yin qiao mai (yin motility vessel) was involved, and therefore the following points were used: zhao hai KI-6, jiao xin KI-8, and jing ming BL-1 or yin tang EX-HN-3. If both jiao xin KI-8 and fu yang BL-59 were painful, zhao hai KI-6 was used with the reinforcing technique, and shen mai BL-62 with the reducing technique, together with jing ming BL-1 or yin tang EXHN-3. In the subsequent sessions, other synchronizers were treated, as were the underlying zang fu (organ) disorders (see previous chapters). Particular emphasis was put on the palpation of the five outer bladder “spirit” points: po hu BL-42, shen tang BL-44, hun men BL-47, yi she BL-49, zhi shi BL-52, as well as gao huang shu BL-43. As the cause of insomnia is frequently retained emotions, these points are likely to be sensitive to palpation, in which case needling with reduction technique is used.

Patients

* Acknowledgements: The study, The Effect of Acupuncture in the Treatment of Insomnia, 1994, was supported by project no. 4034–35871 of the Swiss National Science Foundation (Complementary Medicine). The author would like to thank Dr. Gerald Langel, the director of CENAS and co-author of the study project, Dr. K. v. Berlepsch, for his support and helpful comments throughout the course of this project, Dr. Helli Merica, for her valuable counsel, and Mr. Philippe Miserez at the CENAS laboratory, for his indispensable technical support.

The study included 40 patients aged 26–60 years (22 women and 18 men) with an average age of 46. They had all suffered from difficulties maintaining sleep (waking early, more or longer periods awake during the night) for at least 3 months. In addition, several patients also had difficulties falling asleep. Secondary sleep disorders due to a severe physical or psychiatric illness were not

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included, nor were cases of insomnia due to alcohol abuse, drugs, noise, and so on. Any medication with sedating or hypnotic drugs had to be discontinued for at least 2 months prior to the start of the study. During the study no analgesic, anti-inflammatory, or anti-histaminic drugs were allowed; the birth control pill was, however, allowed. At the start of the study, the patients underwent a physical examination. A detailed patient history served to find out how the sleep disorder had developed since childhood and in which circumstances. In addition, a complete examination according to Traditional Chinese Medicine (TCM) was carried out, including an interview, tongue diagnosis, pulse diagnosis, and palpation of the acupuncture points. This allowed the insomnia to be classified according to the patient’s energy patterns. The characteristics of the two groups were as follows: ● Group A: average age 46.25 (standard deviation [SD] = 8.90) years; average insomnia 7.95 years ● Group B: average age 46.05 (SD = 10.21) years; average insomnia 6.20 years

Methodology The patients were randomized to two groups. Group A received personalized acupuncture treatment, while those in Group B were needled outside the channels and served as a control group. Only the treating acupuncturist knew which patient belonged to which group. The patients completed standardized questionnaires before and after the study period, in the absence of the therapist. One polysomnographic session took place at the beginning of the study, and another 0–3 days after the last acupuncture (or control needling) treatment. In clinical studies that investigate sleep disorders, at least two polysomnographic sessions are usually needed, after one night of acclimatization. In our study, which did not concentrate on the type of insomnia but rather aimed to compare a treated with an untreated group, one polysomnographic recording before the beginning of the treatment and one at the end of the study was considered to be sufficient.

Table 6.1 ranks the most frequent complaints according to group. The TCM patterns observed (several patterns being possible in the same patient) in the 20 cases treated in Group A were: ● Nine cases of blood vacuity ● Five cases of yin vacuity ● Two cases of damp–heat ● Eleven cases of liver disharmony patterns (blood or yin vacuity or qi stasis) ● Nine cases of heart disharmony patterns (blood or yin vacuity) ● Six cases of kidney disharmony patterns (yin vacuity) Table 6.1 Most frequent sleep complaints Complaint

Group A Group B

Frequent waking

55%

50%

Difficulty falling asleep

55%

45%

Waking up between 1 a.m. and 3 a.m.

40%

70%

Waking early (between 4 a.m. and 5 a.m.)

30%

30%

Superficial sleep

50%

40%

Frequent dreams

35%

30%

Bad dreams

30%

25%

Snoring

10%

10%

Agitation

20%

25%

Weariness on waking

50%

55%

10%

0

Somnambulism

5%

0

Paresthesia (pins and needles)

5%

0

Waking up startled

5%

0

Nocturnal sweating

5%

10%

Other complaints Impatience

Nocturnal hot flashes

10%

Hot feet

5%

Breathlessness

5%

Palpitations Hunger or thirst

10% 5%

Clinical Study on Acupuncture and Insomnia

●

Four cases of spleen/stomach disharmony patterns (stomach yin vacuity, spleen qi vacuity with dampness)

● ● ●

Protocols for the Subjective Evaluation of Sleep

● ● ●

Sleep was assessed subjectively using several questionnaires: ● One questionnaire concerning the night spent in the sleep laboratory ● The Jenkins Sleep Questionnaire ● The Medical Outcomes Study (MOS): Energy and Fatigue module (MEF) ● The Medical Outcomes Study (MOS): Sleep module (MS) The last three questionnaires were completed both before and after the study. Further, a sleep diary was kept for the duration of the study in order to monitor each patient’s reactions and, if necessary, to modify the treatment.

Protocols for the Objective Evaluation of Sleep The patients had to check in at the CENAS sleep laboratory, near Geneva, Switzerland, at 8 p. m. A technician fastened 10–20 electrodes according to international standards. Conventional criteria according to the Rechtschaffen and Kales sleep scoring manual (1968) were used with a derivation of C3-A2. Electrodes to measure eye movements were placed on the exterior canthus, while muscle tone was measured on the jaw (transverse muscle of the chin). All electrodes were noninvasive. They were fixed onto the scalp using a mixture of clay and glycerine, or were glued onto the bare skin. The signals they recorded were stored on a computer and amounted to approximately 100 megabytes of data for one night. A preanalysis was carried out online, but a final, fully automated data analysis took place in a second phase and encompassed the data for the entire night. A visual control performed by the technician was necessary in order to check for possible anomalies during the automated analysis. The following parameters were measured and stored for analysis:

● ● ●

Check-in time (which was kept as constant as possible) Total duration of sleep Duration and percentage of awakenings during the night Early morning awakening Duration of the sleep Stages 1, 2, 3, and 4 Delta activity Duration, latency, and percentage of rapid eye movement (REM, or paradoxical) sleep Number of sleep cycles and their duration Efficacy indices

Results Objective Evaluation by Polysomnography In order to evaluate objective changes in sleep quality, the variables recorded in the sleep laboratory before the acupuncture treatment (night 1) were compared with those recorded after completion of the treatment (night 2). The results are presented below in four different categories that illustrate: ● A1: Sleep–wake comparison ● A2: Orthodox sleep ● A3: Paradoxical sleep ● A4: Continuity of sleep Each of the following tables gives the average (X) and the standard deviation (SD) for each variable, as well as the probability (P) obtained from the t-test. The difference between night 1 and night 2 was considered statistically significant for all P values equal to or less than 0.05. However, since the variables do not always show a Gaussian distribution, a nonparametric analysis was also performed in order to validate the results of the paired t-test. In the tables below, P values in parentheses indicate a significant difference only for the parametric test but not for the nonparametric test. In this case, we considered that the observed difference between the two nights was not statistically significant.

111

112

6 Clinical Evaluation

Sleep–Wake Comparison (Table 6.2) Group A. The total duration of sleep and the efficacy index increased significantly between the two recordings before and after treatment, whereas the values for latency of sleep, waking hours, and Stage 1 diminished. This is indicative of a net improvement in the quality of sleep. Group B. There was no noticeable difference between the two recordings, possibly even a shorter sleep with more hours awake. Orthodox Sleep (Table 6.3)

means no change, and a negative difference means a worsening of values. ● The Jenkins Sleep Questionnaire (Table 6.6) concentrates first on difficulties falling asleep then on maintaining sleep over the previous month. Each of these two questions allows six answers, which are graded from 1 to 6. ● The MOS Energy and Fatigue module questionnaire (MEF) also concentrates on the last month and asks, “How often during the last 4 weeks did you …?” (Table 6.7). ● The MOS Sleep module questionnaire (MS) also concentrates on the previous month and asks, “How often during the last 4 weeks did you …?” (Table 6.8).

Group A. No comment. Group B. The amount of Stage 4 sleep was markedly reduced in night 2, indicating diminished sleep quality. REM Sleep (Table 6.4) Group A. The significant increase in paradoxical sleep (P<0.001) was an unexpected but very interesting finding. Group B. There was no significant difference between the results before and after treatment. Continuity of Sleep (Table 6.5) Group A. The reduction in the number of changes of sleep stage is indicative of more stable sleep and a tendency toward fewer periods awake. Group B. There were no significant changes in the results before and after treatment.

Subjective Assessment of Sleep Three kinds of patient questionnaire were used for the evaluation. The difference between night 1 and night 2 was taken as a qualitative indication of a change during the treatment period. The numerical values assigned to various answers were arbitrary but were chosen in such a way that value 1 was always the best and value 6 the worst. Therefore, a positive difference for night 1 minus night 2 always signifies an improvement, no difference

The differences between night 1 and night 2 are shown in Tables 6.9 and Table 6.10 for each patient and each question. The individual values are totaled in the penultimate column in the table. This summation illustrates what happened to each patient in terms of the subjective assessment of his or her situation and is shown in Fig. 6.1 and Fig. 6.2. It goes without saying that a statistical evaluation of these values is not meaningful, but the two figures indicate a clear trend in the result. The diary kept over the entire study period and the questionnaire concerning the nights spent in the sleep laboratory were used for information purposes but were not systematically evaluated.

Discussion and Analysis of Results The results of this study show that acupuncture treatment for insomnia is judged to be beneficial on both objective and subjective assessments. Following acupuncture treatment, the patients slept for longer and enjoyed better-quality sleep. The number of waking periods decreased and their sleep was more stable, as judged by the reduced number of changes in sleep stages. The changes in sleep characteristics moved toward the norm, that is, the duration of orthodox sleep increased, with a tendency toward prolonged Stage 4 sleep. In summary, patients’ sleep became more restful. The increased REM sleep observed following acupuncture treatment is unexpected and interesting. Although we have no obvious explanation

Clinical Study on Acupuncture and Insomnia

Table 6.2 Sleep–wake comparison Variable

Night 1

P

Night 2

X

SD

X

SD

430.15

(46.77)

476.48

(36.70)

<0.001

Latency of sleep

20.73

(14.87)

14.83

(11.08)

0.059

Waking hours

81.68

(50.70)

43.83

(34.83)

0.001

Stage 1

28.55

(10.12)

20.73

(7.66)

<0.001

Efficacy index

84.17

(9.74)

91.60

(6.70)

0.001

6.78

(12.27)

4.68

(10.74)

0.603

15.83

(9.74)

8.40

(6.70)

0.001

460.23

(52.32)

432.60

(60.73)

(0.019)

Latency of sleep

15.20

(12.16)

14.03

(14.00)

0.634

Waking hours

52.32

(43.90)

78.80

(49.66)

0.020

Stage 1

22.65

(13.00)

22.23

(11.51)

0.883

Efficacy index

89.70

(8.82)

84.48

(9.90)

0.017

Early morning awakening

12.33

(17.54)

14.58

(20.98)

0.636

Waking hours (%)

10.30

(8.82)

15.53

(9.90)

0.017

Group A (treated) Total duration of sleep

Early morning awakening Waking hours (%) Group B (control) Total duration of sleep

Table 6.3 Orthodox sleep Variable

Night 1

P

Night 2

X

SD

X

SD

Non-rapid eye movement total

333.55

(31.19)

357.15

(28.40)

0.015

Stage 2

242.53

(42.78)

267.33

(33.68)

0.050

Stage 3

26.13

(6.99)

23.85

(10.37)

0.398

Stage 4

36.35

(18.77)

45.25

(14.52)

0.092

Delta

62.48

(21.10)

69.10

(15.75)

0.203

Group A (treated)

Group B (control) Non-rapid eye movement total

358.0

(39.90)

326.55

(50.33)

0.001

Stage 2

252.78

(53.17)

234.05

(60.97)

0.078

Stage 3

34.20

(14.17)

30.82

(17.58)

0.374

Stage 4

48.38

(35.66)

39.38

(30.48)

0.024

Delta

82.58

(47.24)

70.20

(44.81)

(0.040)

113

114

6 Clinical Evaluation

Table 6.4 REM sleep Variable

Night 1

P

Night 2

X

SD

X

SD

REM sleep (total)

96.60

(22.64)

119.33

(22.86)

<0.001

Latency of REM sleep

106.0

(53.62)

99.98

(53.22)

0.567

REM sleep (%)

1.92

(4.54)

22.93

(4.38)

<0.001

Number of cycles

1.15

(1.09)

4.50

(1.10)

0.217

Duration episode stage 1

15.93

(10.71)

17.13

(12.42)

0.713

Duration episode stage 2

29.83

(18.93)

27.63

(11.22)

0.677

Duration episode stage 3

22.24

(10.82)

39.53

(14.20)

<0.001

Duration episode stage 4

27.54

(13.31)

26.09

(14.11)

0.832

REM sleep (total)

102.23

(30.14)

106.13

(27.93)

0.467

Latency of REM sleep

129.63

(74.16)

114.35

(55.55)

0.412

REM sleep (%)

19.90

(5.70)

20.71

(5.03)

0.449

Number of cycles

4.45

(1.10)

4.45

(1.19)

1.000

Duration episode stage 1

18.15

(10.23)

20.0

(11.24)

0.625

Duration episode stage 2

22.55

(12.57)

21.43

(13.12)

0.741

Duration episode stage 3

26.63

(8.97)

29.66

(11.31)

0.388

Duration episode stage 4

29.09

(15.03)

28.03

(13.87)

0.734

Group A (treated)

Group B (control)

Table 6.5 Continuity of sleep Variable

Night 1

P

Night 2

X

SD

X

SD

Number of sleep stage changes

72.0

(18.87)

56.44

(15.42)

<0.001

Total arousals

42.60

(18.70)

37.85

(22.15)

0.201

Number of sleep stage changes

65.05

(16.92)

61.50

(17.93)

0.295

Total arousals

31.60

(13.30)

34.60

(20.44)

0.423

Group A (treated)

Group B (control)

Clinical Study on Acupuncture and Insomnia

Table 6.6 The Jenkins Sleep Questionnaire “Jenk1”: For how many days during the last month have you had difficulties in falling asleep?

“Jenk2”: For how many days during the last month have you had difficulties in maintaining sleep?

Not at all

–1

–1

1–3 days

–2

–2

4–7 days

–3

–3

8–14 days

–4

–4

15–21 days

–5

–5

22–31 days

–6

–6

Table 6.7 The Medical Outcomes Study: Energy and Fatigue module questionnaire (MEF) “MEFa”: Feel exhausted?

“MEFb”: Have lots of energy?

“MEFc”: Feel enthusiasm and vitality?

“MEFd”: Have enough energy to do what you wanted to do?

“MEFe”: Feel tired?

Never

–1

–6

–6

–6

–1

Very little

–2

–5

–5

–5

–2

From time to time

–3

–4

–4

–4

–3

Quite often

–4

–3

–3

–3

–4

Most of the time

–5

–2

–2

–2

–5

Always

–6

–1

–1

–1

–6

Table 6.8 The Medical Outcomes Study: Sleep module (MS) MSa: Have difficulties falling asleep?

MSb: Wake up and could not go to sleep again?

MSc: Wake up short of breath with a headache?

MSd: Sleep MSe: Sleep as enough to feel much as you rested after needed? waking up?

MSf: Have difficulty in staying awake during the day?

Never

–1

–1

–1

–6

–6

–1

Very little

–2

–2

–2

–5

–5

–2

From time to time –3

–3

–3

–4

–4

–3

Quite often

–4

–4

–4

–3

–3

–4

Most of the time

–5

–5

–5

–2

–2

–5

Always

–6

–6

–6

–1

–1

–6

115

0

0

4

2

4

–1

1

1

0

1

0

1

0

1

2

2

2

1

1

2

Acu3

Acu4

Acu5

Acu6

Acu7

Acu8

Acu9

Acu10

Acu11

Acu12

Acu13

Acu14

Acu15

Acu16

Acu17

Acu18

Acu19

Acu20

0

2

3

0

1

1

0

1

0

1

1

1

1

1

1

1

1

1

1

0

1

1

1

0

1

0

1

1

1

1

0

1

1

1

1

1

1

1

1

0

2

0

–1

0

2

2

1

0

0

1

2

0

1

1

1

1

1

0

1

0

1

1

1

MEFe

2

0

1

2

1

2

1

1

1

1

1

1

0

1

1

4

1

1

2

1

0

1

1

1

1

2

1

0

2

0

2

0

2

0

0

1

–2 1

1

MSb

1

MSa

1

0

2

1

0

0

0

0

0

2

1

0

–2

0

0

1

2

0

2

1

MSc

3 0

–1

1

0

3

2

1

1

0

–1 1

1

1

2

–1

1

1

–3

2

–1

–1

1

1

0

1

MSe

1

1

0

0

1

1

–3

3

0

–2

1

1

1

2

MSd

Note: With two exceptions all patients show a clear trend toward positive values, i. e., toward improvement (10.6 points average per patient).

1

2

1

4

1

1

1

2

1

1

–1

1

1

1

–1 1

–1

–1

1

3

–1

–1

–1 0

0

0

1

3

MEFd

0

0

3

2

MEFc

2

–1

2

0

1

3

2

MEFb

2

1

0

2

0

0

2

1

MEFa

1

2

0

1

0

0

1

0

Acu2

2

Jenk2

0

Jenk1

Acu1

Patient

Table 6.9 Subjective assessment (Group A)

0

0

2

1

1

1

1

1

1

–1

1

1

0

1

0

1

0

1

0

2

MSf

6

18

19

15

11

10

10

13

12

5

13

10

–8

20

–3

12

7

10

13

19

Sum total per patient

10.6

Average sum per patient

116 6 Clinical Evaluation

0

1

1

0

0

0

0

1

–1

3

0

0

0

0

0

0

0

0

0

0

2

Plac.2

Plac.3

Plac.4

Plac.5

Plac.6

Plac.7

Plac.8

Plac.9

Plac.10

Plac.11

Plac.12

Plac.13

Plac.14

Plac.15

Plac.16

Plac.17

Plac.18

Plac.19

Plac.20

2

2

–1

–1 1

0

0

1

–1 0

0

0

1

0

0

0

0

0

0

1

0

0

0

0

1

0

0

1

0

–1

0

–1

1

1

–1 2

0

1

1

–1

1

0

0

0

0

1

1

1

0

0

2

0

0

0

0

0

0

0

0

0

0

1

–1 0

–1

2

1

2

0

0

2

0

0

0

0

0

0

0

0

0

2

–1 0

0

0

0

0

0

0

1

0

0

0

0

0

0

1

1

0

–1

1

0

–2 0

0

2

MSc

1

1

MSb

2

0

1

3

MSa

0

0

1

1

0

2

0

–1 0

0

MEFe

0

MEFd

0

1

0

MEFc

0

1

0

0

1

0

0

0

1

1

0

0

0

0

–1

1

0

–1

1

1

1

2

1

1

–1

0

0

0

0

1

0

–1

–1

1

MEFb

MEFa

0

0

2

0

0

0

0

0

0

0

–1

0

1

0

1

1

0

0

1

1

MSd

Note: With three exceptions, all patients showed a positive effect, weaker than Group A and perhaps a placebo effect (3.45 points average).

2

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

1

0

0

Plac.1

Jenk2

Jenk1

Patient

Table 6.10 Subjective assessment (Group B)

1

0

0

0

1

0

0

0

0

0

–2

0

0

1

1

0

1

0

2

1

MSe

1

0

0

–1

1

0

0

2

0

0

–1

0

–1

0

0

1

–2

1

0

0

MSf

17

–2

2

1

2

4

3

4

2

1

–6

4

–4

9

7

4

4

3

8

6

Sum total per patient

3.45

Average sum per patient

Clinical Study on Acupuncture and Insomnia 117

6 Clinical Evaluation

Fig. 6.1 Subjective assessment of Group A.

25

15 10

–10

Acu.20

Acu.19

Acu.18

Acu.16 Acu.17

Acu.15

Acu.14

Acu.13

Acu.11 Acu.12

Acu.9

Acu.10

Acu.7 Acu.8

Acu.6

Acu.5

–5

Acu.4

0

Acu.2 Acu.3

5 Acu.1

Therapeutic effect

20

Patient number

Fig. 6.2 Subjective assessment of Group B.

25 20 15 10

–10

Plac.20

Plac.19

Plac.18

Plac.16 Plac.17

Plac.15

Plac.14

Plac.13

Plac.11 Plac.12

Plac.9

Plac.10

Plac.7 Plac.8

Plac.6

Plac.5

–5

Plac.4

0

Plac.2 Plac.3

5 Plac.1

Therapeutic effect

118

Patient number

for this phenomenon, we can assume that acupuncture reduces a stressful situation. The subjective assessment of sleep also points to an improvement after acupuncture. It is, however, interesting to note that the control group also felt better subjectively, although not as obviously as the acupuncture group. It remains to be seen whether this is due to a placebo phenomenon. Interestingly, the patients in the control group seem to sleep less well after a series of sham needlings, especially when judged objectively by polysomnography. Patient recruitment was not easy. Originally, it

was planned to include patients with recent insomnia of not more than 1 year in order to show that three to five sessions of acupuncture would be sufficient to effect treatment. However, this type of patient was not willing to participate in a strictly controlled study of 4–6 weeks’ duration, to spend 2 nights in a sleep laboratory, and to regularly go to the doctor for a problem that seemed transient. As the majority of the patients in this study were suffering from chronic insomnia, it is quite conceivable that the study design of three to five sessions is too short a treatment period for such patients. Of the 20 patients treated, we consider

Other Clinical Studies on Insomnia and Other Sleep Disorders

six (30%) to have good results and 11 (55%) only fair results. Although it was not expected that all 20 would benefit, the fact that only 30% were considered to have had good results is not considered a satisfactory result. Patients who have been suffering from insomnia for, for example, more than 10 years will most likely need a longer treatment period in order to be satisfied with the results and to stop taking medication, the latter probably being one of the few measurable criteria of treatment success. This reasoning tallies with Chinese studies that recommend 3–6 months of therapy for long-term insomnia. However, our encouraging results after only three to five sessions even in cases of chronic insomnia seem to confirm the theory that carefully individualized acupuncture is more effective than frequently performed standardized acupuncture. The influence of the therapist himself or herself also cannot be excluded, since it is not possible to perform double-blind acupuncture studies. There are numerous indications that the intention of the treating practitioner plays a role in therapy, but this factor has yet not been quantified. On the other hand, the patient’s attitude toward therapist and therapy also influences the outcome and probably plays a role in separating responders from nonresponders. This, however, applies to many fields of human medicine, although it would be less applicable to cases of successful acupuncture treatment in veterinary medicine, in which the animal will not have any prior knowledge or preconceived ideas about the treatment. Even though these issues have not yet been explored scientifically, the results of our study are encouraging enough to recommend individualized acupuncture according to the TCM method for the treatment of insomnia.

Other Clinical Studies on Insomnia and Other Sleep Disorders Over the last three decades, there have been a number of publications on the therapeutic benefits to be derived from acupuncture in all types of sleep disorder. Previously, the only studies that have attempted to objectively demonstrate a measurable electrophysiological effect using polysom-

nography were Russian (Dallakian et al. 1985, Kochetkov et al. 1983, Tabeeva and Akhtiamov 1980). Recently, more and more studies have been attempted with an objective evaluation, mostly in China. All the studies tend to demonstrate that acupuncture has a beneficial effect on sleep disorders: ● A Russian study in 1980 of 15 patients presenting secondary psychogenic insomnia showed a marked subjective and objective improvement after acupuncture treatment (Tabeeva and Akhtiamov 1980). ● Another Russian study in 1983 on 41 hypochondriacal patients suffering from insomnia and treated by acupuncture showed an objective improvement. The authors suggest a thalamocortical site of action for acupuncture (Kochetkov et al. 1983). ● In 1993, a Japanese polygraphic study of a case of insomnia demonstrated a decrease in superficial sleep in favor of an increase in deep sleep (Shinomiya et al. 1993). ● A Belgian study in 1987 involving 10 cases of secondary insomnia due to uremic pruritis treated with electro-acupuncture showed a clear improvement compared with a control group (Duo 1987). The following Chinese studies have explored the effects of acupuncture on insomnia: ● Fifteen out of 16 insomniac patients showed a clear improvement in a 1977 study after injection of lidocaine into the auricular acupuncture points. All the patients maintained this improvement over a follow-up of 3 months (Lee 1977). ● In 1985, 86 cases of insomnia were treated using da ling PC-7 and wei guan TB-5. There were 39 cases of complete recovery, 36 of partial improvement, and 11 with little improvement. The therapeutic protocol was not described (Ren 1985). ● In 1988, a similar study involving 62 patients with insomnia treated by selective ear point stimulation using Semen vaccariae (ear seeds) showed a success rate of 95% compared with a control group receiving a standardized treatment, which showed only 64% improvement (Yang 1988). ● In 1989, 10 cases of somnambulism were treated with acupuncture and herbs, with eight

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6 Clinical Evaluation

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cures, one failure, and one withdrawal after 30– 60 sessions (Li 1989). In 1990, a study tested the therapeutic efficacy of plum blossom stimulation of yin tang EXHN-3 in insomnia (Xu 1990). In 1990, a study was carried out on 160 participants, half of whom were treated using the same auricular points, and half of whom received 10 mg of diazepam. At the start of the study, the diazepam group showed a greater improvement. However, after 30 days of treatment, the auricular acupuncture group showed better results (P < 0.01) (Lian and Yan 1990). In 1994, 124 cases of dyssomnia were treated with a combination of si shen cong EX-HN-1, bai hui GV-20, shen men HT-7, and tai xi KI-3, on a daily basis, with a 3-day break every 7–10 days. The average duration of treatment was 30 days. After treatment, 59% of patients showed a total recovery, 21% a marked improvement, 8% a partial improvement, and 12% no change (Xie et al. 1994). In 2000, 38 cases of insomnia were treated with moxibustion on yong quan KI-1 on a daily basis for 15–20 minutes, which yielded a 100% success rate (Ren 2000). In 2007, a randomized controlled study of the effect of acupuncture on sleep quality was carried out on 46 patients with primary insomnia who were divided into one group treated with acupuncture and one control group. The points bai hui GV-20, shen ting GV-24, and shen men HT-7 were selected. The control group was given estazolam orally. The results showed an effectiveness in 83.3% of the acupuncture group versus 72.7% in the control group (P<0.05). Estazolam was better at prolonging sleep time, but acupuncture proved superior in the treatment of somnipathy and decreased daytime performance (Xuan et al. 2007). In 2007, 276 patients with insomnia were randomly assigned to two groups. One group was treated with electro-acupuncture at si shen cong EX-HN-1. The control group received an oral treatment of Tian Meng (Sweet Dreams) over a total period of 3 weeks. The results were monitored by somnography. Both groups showed a significant improvement, although the electro-acupuncture group improved more (P < 0.01) (Tang et al. 2007). A 2007 study divided 200 patients with insom-

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nia randomly into a test group and a control group. The test group was treated with the needling method to regulate wei qi (defensive energy) and strengthen the brain with bai hui GV-20, da zhui GV-14, shen mai BL-62, zhao hai KI-6, and the ear points yuan zhong and shen men. The control group was treated with si shen cong EX-HN-1, shen men HT-7, and san yin jiao SP-6. Acupuncture was given once daily for 15 days. The Pittsburgh Sleep Quality Index (PSQI) was used to score before and after treatment. The results showed a total effective rate of 89.0% in the test group and 65.0% in the control group (P < 0.01); the difference between the PSQI scores before and after was –9.15 ± 5.68 in the test group, –5.64 ± 5.73 in the control group (P < 0.01) (Gao et al. 2007). A 2007 review of 878 papers on treating insomnia with auricular acupuncture showed the recovery and improvement rates to be significantly higher than were seen in patients treated with diazepam (P < 0.05). The efficacy of using Semen vaccariae was better than that seen for the controls (P < 0.01), while treatment with magnetic pearls did not show any statistical significance (P = 0.28). Six commonly used auricular acupuncture points were shen men, heart, occiput, subcortex, brain, and kidney (Cheuk et al. 2007). A 2008 clinical study on the visceral differentiation-based acupuncture therapy for insomnia involved 70 cases of participants with insomnia who were randomly divided into a treatment group and a control group. The former was treated by acupuncture based on visceral differentiation and the latter by routine acupuncture therapy. The clinical effects were significantly better in the treatment group than that of the control group (P < 0.05) (Li Ling et al. 2008). A 2009 study on electro-acupuncture for primary insomnia involved a randomized controlled trial on 60 Chinese adult volunteers presenting insomnia for 3 nights or more per week for at least 3 months. The treated group received electro-acupuncture at yin tang EX-HN3, bai hui GV-20, bilateral ear shen men, si shen cong EX-HN-1, and an mien EX-HN-54 three times per week for 3 weeks. The control group received sham acupuncture using Streitberger placebo needles at the same points. Results showed a slight advantage of electro-acupunc-

Other Clinical Studies on Insomnia and Other Sleep Disorders

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ture over sham acupuncture in the short-term treatment of primary insomnia (Yeung et al. 2009). A 2009 study on the influence of auricular plaster therapy on sleeping structure in patients with obstructive sleep apnea syndrome showed that the auricular plaster therapy significantly improved the hypoventilation index, respiratory parameters, as well as the sleeping parameters such as the time and rate of sleep at Stages 1 and 2, and the waking time and rate (Wang et al. 2009). In 2009, a study was carried out on the effect of acupuncture on blood oxygen saturation in patients with obstructive sleep apnea–hypopnea syndrome. Thirty patients with OSAHS were treated with acupuncture at shang lian quan EX-HN-15, feng fu GV-16, ya men GV-15, and feng chi GB-20 for three to five sessions per week for a total of 30 sessions. The following parameters were evaluated before and after treatment: apnea/hypopnea index (AHI), mean blood oxygen saturation (MSaO2), the lowest blood oxygen saturation (LSaO2), oxygen desaturation ≥ 4% index (ODI4), the mean blood oxygen saturation of oxygen desaturation when SaO2 < 90%, the longest time of oxygen saturation ≥ 4%. The effective rate of acupuncture was 23.3% for OSAHS. After acupuncture, AHI and ODI4 significantly reduced (P < 0.01); LSaO2 significantly increased (P < 0.01); MSaO2 and the mean blood oxygen saturation of oxygen desaturation when oxygen saturation SaO2 < 90% significantly enhanced (P < 0.05); the longest time of oxygen saturation ≥ 4% did not significantly change (Xu et al. 2009).

List of some other references of Western and Chinese studies: ● “Effects of individualized acupuncture on sleep quality in HIV disease” (Phillips 2001). ● “Effects of acupuncture therapy on insomnia” (Sok et al. 2003).

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“Intradermal acupuncture on Shen men HE-7 and nei-kuan acupoints in patients with insomnia after stroke” (Kim et al. 2004). “Acupuncture increases nocturnal melatonin secretion and reduces insomnia and anxiety: a preliminary report” (Katzman et al. 2004). “Acupuncture for insomnia in pregnancy – a prospective, quasi-randomised, controlled study” (Da Silva et al. 2005). “Role of acupuncture in the treatment of insomnia: a comprehensive review” (Kalvapalli and Singareddy 2007). ”Acupuncture for insomnia” (Cheuk et al. 2007). “Treatment of moderate obstructive sleep apnea syndrome with acupuncture: a randomised, placebo-controlled pilot trial” (Freire et al. 2007). “A systematic review of the effects of acupuncture in treating insomnia” (Huang et al. 2009). “Acupuncture for the treatment of insomnia; a systemic review of randomised controlled trials, involving 3811 patients, comparing acupuncture treatment versus no treatment; acupressure versus placebo acupressure; acupuncture and herbs versus herbs alone. The conclusion states that acupuncture appears to be affective in the treatment of insomnia” (Cao et al. 2009). “Auriculotherapy and aircrew with circadian desynchronosis: aeromedical implications” (Little and Niemtzow 1999/2000). This study involved only five patients, but the treatment seems a promising alternative for jet lag management.

Basically, all the studies reviewed show the efficacy of acupuncture treatment in insomnia. The few studies comparing acupuncture with drug treatments even show the superiority of acupuncture in its recuperative effects and on daytime activity and performance.

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Appendices

Appendix 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . Appendix 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

124 129 134 137 144

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Appendix 1 Index of Sleep-related Symptoms and Acupuncture Points

Agitation

Shen men HT-7, xi men PC-4, tai bai SP-3, guan chong TB-1, zheng ying GB-17, yin tang EX-HN-3, yi ming EX-HN-14/an mien EX-HN-54

All insomnia

Shen men HT-7, si shen cong EX-HN-1

Anxiety when lying down

Shen feng KI-23

Anxiety

Yong quan KI-1, ling xu KI-24, nei guan PC-6, da ling PC-7, zhong chong PC-9, yu ji LU-10, da du SP-2, que pen ST-12, da ju ST-27, feng long ST-40, xin shu BL-15, pi shu BL-20, gao huang shu BL-43, shen tang BL-44, hun men BL-47, tou lin qi GB-15, hou ding GV-19, bai hui GV-20, shen ting GV-24, guan yuan CV-4, jiu wei CV-15, si shen cong EX-HN-1

Attachment

Da ling PC-7

Cannot sleep at all

Lao gong PC-8

Difficulty falling asleep

Tian jing TB-10

Discontentment

Da ling PC-7, lao gong PC-8

Dislike of neck tightness

Que pen ST-12

Dream of flowers

He gu LI-4

Dream of untilled fields

Qu chi LI-11

Dream of falling or sinking

Di ji SP-8, tian yu TB-16

Dream of standing on the head

Tian yu TB-16

Dream of climbing/singing

Feng long ST-40

Dream of landscapes

He gu LI-4

Dream of narrow passes

Da du SP-2, hou xi SI-3

Dream of ruins

Da du SP-2

Dream of snakes

Xuan shu GV-5

Dream of the dead

Xin shu BL-15; also zu qiao yin GB-44 + shang qiu SP-5

Dream of sex

Tian zhu BL-10, xin shu BL-15, shen shu BL-23

Dreams of humiliation

Xia xi GB-43

Drooling + eye crusting

Bai hui GV-20 or si shen cong EX-HN-1 + que pen ST-12 + wei yang BL-39 and guan chong TB-1

Dropping (feeling of)

Di ji SP-8

Eating to sleep

Liang men ST-21; also bai hui GV-20 + que pen ST-12 + zu san li ST-36 and li dui ST45

Enuresis (children)

Xin shu BL-15

Excessive dreaming

Shen men HT-7, yin bai SP-1, li dui ST-45, hou xi SI-3, xin shu BL-15, ben shen GB-13, zu qiao yin GB-44

Appendix 1

Eye crust + drooling

Bai hui GV-20 or si shen cong EX-HN-1 + que pen ST-12 + wei yang BL-39 and guan chong TB-1

Falling asleep all the time

Er jian LI-2

Fear of the dark

Zhong chong PC-9

Fear

Tai xi KI-3, zhu bin KI-9, xin jian LR-2, qu chi LI-11, xin shu BL-15, lu xi TB-19, shuai gu GB-8, xin hui GV-22

Frequent waking

Shen men HT-7

Fright wind

Yong quan KI -1, tai chong LR-3

Guilt, embarrassment

Tai yuan LU-9, gong sun SP-4, xi men PC-4, nei guan PC-6

Infantile crying

Jian shi PC-5

Infantile fears

Yin bai SP-1

Infantile insomnia (pain)

Kun lun BL-60 (dentition)

Infants needing to be carried

You men KI-21, shang qiu SP-5

Insomnia after midnight

Liang men ST-21

Insomnia before midnight

Nao hu GV-17

Insomnia from emotions

Kun lun BL-60

Insomnia from excitement

Tai yuan LU-9

Insomnia from fatigue

San yin jiao SP-6, tian zhu BL-10, yi xi BL-45, he gu LI-4, zhej jin GB-23, tao dao GV13

Insomnia from fear

Xia xi GB-43

Insomnia from irritability

Bai hui GV-20 + que pen ST-12 + zu san li ST-36 and li dui ST-45

Insomnia from nervousness

Que pen ST-12

Insomnia from sadness

Tian jing TB-10

Insomnia from weakness

He gu LI-4

Insomnia from worry

Shen cang KI-25, da ju ST-27

Insomnia in children

Shao shang LU-11

Insomnia with agitation

Zhao hai KI-6, shu fu KI-27

Insomnia

Shen men HT-7, shao fu HT-8, yong quan KI-1, tai xi KI-3, shen cang KI-25, yu zhong KI-26, jian shi PC-5, nei guan PC-6, da ling PC-7, xin jian LR-2, tai chong LR-3, zhong fu LU-1, yun men LU-2, tai yuan LU-9, yu ji LU-10, da du SP-2, gong sun SP-4, san yin jiao SP-6, zu san li ST-36, hou xi SI-3, jing ming BL-1, gao huang shu BL-43, shen tang BL-44, shen mai BL-62, guan chong TB-1, lu xi TB-19, wan gu GB-12, ben shen GB13, tou lin qi GB-15, zheng ying GB-17, feng chi GB-20, ling tai GV-10, qiang jian GV18, hou ding GV-19, bai hui GV-20, xin hui GV-22, qi hai CV-6, jiu wei CV-15, yin tang EX-HN-3, si shen cong EX-HN-1, yi ming EX-HN-14 / an mien EX-HN-54

Jerking at night

Si zhu kong TB-23

Jet lag

Wei guan TB-5 (with he gu LI-4)

Likes to lie down

San jian LI-3, shou wu li LI-13

Mental restlessness

Shao fu HT-8, shen feng KI-23, shen cang KI-25, lao gong PC-8, yin bai SP-1

Mouth dryness, thirst

Bai hui GV-20 + que pen ST-12 + xia ju xu ST-39 and shao ze SI-1

Needing silence

Nei ting ST-44

Night crying in children

Zhong chong PC-9

Night terrors

Jian shi PC-5, han yan GB-4, shuai gu GB-8, zhe jin GB-23, guan yuan CV-4

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Nighttime itching

Bai hui GV-20 + que pen ST-12 + yang ling quan GB-34 and zu qiao yin GB-44

Nightmares

Yin bai SP-1, shang qiu SP-5, nei ting ST-44, li dui ST-45, zan zhu BL-2, tian zhu BL10, ben shen GB-13, tou lin qi GB-15, zu qiao yin GB-44

Nocturia

San yin jiao SP-6

Nocturnal spermatorrhea

Xin shu BL-15, shen shu BL-23

Obsessive thinking

Da du SP-2, shang qiu SP-5

Oppression/ghost

Yin bai SP-1

Persistent insomnia

Shu fu KI-27

Psychic stress

Ling xu KI-24

Restless extremities

Nei ting ST-44

Restless legs

Qu quan LR-8, lu xi TB-19 (with TB-2), yang ling quan GB-34, yang jiao GB-35; also bai hui GV-20 + que pen ST-12 + wei zhong BL-40 and zhi yin BL-67

Restlessness/sleep

Tian chi PC-1, tian fu LU-3, yin bai SP-1, gong sun SP-4, he gu LI-4 with tai chong LR-3, si zhu kong TB-23, yi ming EX-HN-14 / an mien EX-HN-54

Seeing ghosts

Xin jian LR-2

Sensitive to noise

Yi ming EX-HN-14 / an mien EX-HN-54

Sexual dreams

Tian zhu BL-10, xin shu BL-15, shen shu BL-23

Sleep-talking (ghost talk)

Shen men HT-7, tian fu LU-3

Sleep-walking

An mien I EX-HN-52, an mien II EX-HN-53

Sleepiness

Er jian LI-2, li dui ST-45, jing ming BL-1, shen mai BL-62, ri yue GB-24

Sleeping with open eyes

Shao shang LU-11

Superficial sleep

Pi shu BL-20, xin shu BL-15, gan shu BL-18

Teeth grinding

He gu LI-4; also bai hui GV-20 + que pen ST-12 + shang ju xu ST-37 and shang yang LI-1

Tired but cannot sleep

You men KI-21

Vague fear feeling

Hun men BL-47

Visual dreams

Yong quan KI-1

Waking between 1 a.m. and 3 a.m.

Zhong fu LU-1, yun men LU-2, ting hui GB-2

Waking in a bad mood

Yu zhong KI-26

Waking to eat

Hui zong TB-7

Waking with a puffy face

Zhong fu LU-1

Waking with laziness

Tai bai SP-3

Waking with puffy eyes

Tian fu LU-3

Worry

Da du SP-2, xia xi GB-43

Appendix 1

Acupuncture Points Containing the Characters Shen, Ling, and Gui Acupuncture Points Containing the Character Shen—神

Pin yin

Chinese character

English translation

Channel and point

Indications

Shen men

神門

Spirit door

HT-7

Depression, anxiety, insomnia, hysteria, loss of memory, retardation

Shen dao

神道

Spirit path

GV-11

Sadness, fear, amnesia, regrets

Shen ting

神庭

Spirit hall

GV-24

Severe anxiety, mania, hysteria, nightmares

Shen feng

神封

Spirit seal

KI-23

Mental restlessness, anxiety when lying down

Shen cang

神藏

Spirit storage

KI-25

Insomnia, mental restlessness, negativity, waking up in a bad mood

Ben shen

本神

Spirit root

GB-13

For anger, anxiety or depression

Acupuncture Points Containing the Character Ling (Soul)—靈

Pin yin

Chinese character

English translation

Channel and point

Ling dao

靈道

Path of the Soul

HT-4

Cheng ling

承靈

Supporting the Soul

GB-18

Qing ling

青靈

Blue-Green Soul

HT-2

Ling xu

靈虛

Soul Ruins

KI-24

Ling tai

靈台

Soul Tower

GV-10

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Acupuncture Points Containing the Character Gui (Ghost) 鬼 Pin yin

Chinese character

English translation

Channel and point

Chi ze but also called gui tang or gui shou

鬼堂

Ghost palace

LU-5

鬼受

Ghost reception

Tai yuan, also called gui xin

鬼心

Ghost heart

LU-9

Shao shang, also called gui xin

鬼信

Ghost sincerity

LU-11

Shou san li, also called gui xie

鬼邪

Ghost evil

LI-10

Qu chi, also called gui tui or gui chen

鬼腿

Ghost leg

LI-11

鬼臣

Ghost minister

鬼床

Ghost bed

鬼林

Ghost forest

Zu san li, also called gui xie

鬼邪

Ghost evil

ST-36

Yin bai, also called gui yan or gui lei

鬼眼

Ghost eye

SP-1

鬼壘

Ghost pile

Shen mai, also called gui lu

鬼路

Ghost road

BL-62

Jian shi, also called gui lu or gui ying

鬼路

Ghost road

PC-5

鬼營

Ghost camp

Jia che, also called gui chuang or gui lin

ST-6

Da ling, also called gui xin

鬼心

Ghost heart

PC-7

Lao gong, also called gui ying or gui lu or gui ku

鬼營

Ghost camp

PC-8

鬼路

Ghost road

鬼窟

Ghost cave

Cheng jiang, also called gui shi

鬼市

Ghost market

CV-24

Feng fu, also called gui xue or gui zhen or gui lin

鬼穴

Ghost hole

GV-16

鬼枕

Ghost pillow

鬼林

Ghost forest

Xin hui, also called gui men

鬼門

Ghost door

GV-22

Shang xing, also called gui tang or gui gong

鬼堂

Ghost temple

GV-23

鬼宮

Ghost palace

鬼市

Ghost market

鬼宮

Ghost palace

鬼客廳

Ghost reception

Shui gou, also called gui shi or gui gong or ke ting

GV-26

Point Combinations for the Treatment of “Possessions” Sun Si Miao’s 13 Ghost Points—Treatment for Possessions The protocol according to Master Yuen calls for three points to be treated at a time, starting with the set of points corresponding to the symptom patterns, and running through the whole set of 13 points. After each treatment, the needles have to be thrown to the ground.

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First set: GV-26 gui gong or gui shi and LU-11 gui xin and SP-1 gui yan for changes in behavior, starting to see things, thinking and seeing things differently Second set: PC-7 gui xin for something sitting on the chest; BL-62 gui lu for going places one does not know, yin-type places, eyes wide open; GV-16 gui xue or ghui zhen for strange dreams

Appendix 2

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Third set: ST-6 gui chuang or gui lin for introversion, withdrawal, hiding places; CV-24 gui shi for talking to imaginary people, schizophrenia; PC-8 gui ying or gui ku for delusions, paranoia, conspiracy theory Fourth set: GV-23 gui tang; CV-1 gui cang for self-mutilation, suicidal thoughts, risk-taking; LI-11 gui tui or gui chen for paleness, a hollow stare, aimless walking; gui fong (which some consider to be yin tang) for hysteria, violent dementia, biting the tongue

Worsley’s Seven Dragons—for Internal and External Demons ●

The Seven Dragons to chase out the internal demons: – Extra point (1/4 Cun below jiu wei CV-15) – Tian shu ST-25 – Lan wei xue EX-LE-13 – Jie xi ST-41 The treatment is done in a spiral form: ● Start in order from the point below CV-15 ● Followed by ST-25, on the right for women, left for men ● Followed by ST-25 on the opposite side ● Followed by lan wei xue on the left for women right for men ● Followed by lan wei xue on the opposite side ● Followed by jie xi St-41 on the right for women, left for men ● End with jie xi ST-41 on the opposite side ● After 20–30 minutes, remove needles in exactly the reverse order (i. e. starting with ST-41 . . .) ●

The External Dragons for external demons (the impression of something hovering around): – Bai hui GV-20 – Da zhu BL-11, shen shu BL-23, pu can BL-61

Appendix 2 Working with Dreams, by Solange Montakab-Pont Dreams can be a great source of information, providing us with indications about imbalances in patients’ physical bodies as well as in their lives. In

general, the same messages are received from the body–mind combination in dreams as they are in waking life. While awake, the language of the body or of the emotions is reduced to manifestations of pain or of discomfort. But in the dream state, there is more fluidity and freedom, as if all options and possibilities are available and can be tapped into. The hun (ethereal soul) and shen have access to all of these different realms of reality and can draw from all experiences, both personal and collective. Modern psychoanalytic schools, namely the Jungian tradition, propose that all emotions, desires, and the issues that the individual is dealing with in everyday life can be expressed without censure in a dream. The Chinese tradition places great emphasis on the diagnostic significance of dreaming (see Chapter 5).

Energetic and Physiological Effects of Dreams During dreaming, the body undergoes noticeable changes: adrenaline levels rise, blood pressure increases, and the heartbeat alters. Actions and feelings in dreams produce electrochemical responses in the body. Most people have experienced waking up and feeling sick from a bad dream or feeling rejuvenated from a good dream. This and other probable biochemical changes that occur during the dream phase back up theories put forward by the proponents of psychosomatic theory. Dreams affect the physical body, and can even help repair it, providing a veritable self-healing process (Shinomiya et al. 1993). In the mid-1980s, the neuroscientist and pharmacologist Candace Pert discovered the chemical interrelation between the mind, behavior, and the neuroendocrine and immune systems in the form of neuropeptides (Pert 1999). These discoveries form the basis of psycho-neuroimmunology (PNI). In her book Molecules of Emotion, Pert explains that this mind–body interaction primarily takes the form of emotion–body communication, that is, the human physiology is connected to the emotions. Pert works with dreams and believes that dreams are direct messages from the body–mind combination, giving one valuable information about what is happening physiologically as well as emotionally. One of the important functions of dreaming appears to be emotional processing. Ideally, the

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best way to bring about change and a state of balance is by consciously directing one’s dream, for example through lucid dreaming. However, other methods, such as hypnosis, biofeedback, various body-oriented therapies, acupuncture, and guided imagery, appear to trigger the same psycho-physiological responses in a patient when dreaming. In her inspiring article Dreams: A Creative Portal to Healing, Wendy Pannier states: “The limbic system speaks in the language of symbolic imagery: working with dream imagery in the waking state can help change perceptions and resolve conflicts, which are critical keys for mind–body healing” (Pannier 2006).

The Place of Dreams in Modern Psychotherapy Fritz Perls (1893–1970), the founder of Gestalt therapy (Price 1985), who was inspired by the theories of Freud and Jung, believed that dreams contain the rejected, disowned parts of the self. Perls rejected the notion that dreams are part of a universal symbolic language. He believed that each dream is unique to the individual who dreams it. For him, every component of a dream is an aspect of the self. Perls established a sort of dialogue in which the dreamer takes on different roles, interacting with the characters or objects of the dream, in order to acknowledge feelings that have been overlooked or buried.

How to Use Dreams in Psychotherapy Many traditions, both Eastern and Western, agree that dreams are a window to the inner world. In a therapeutic sense, this means that patients’ dreams may provide not only excellent indications to the origins of their problems, but also a means for them to get in touch with hidden aspects of their psyche. In 1967, Vasily Kasatkin, a psychiatrist working at the Leningrad Neurosurgical Institute, published his work Theory of Dreams. He studied the content of 10 240 dreams from 1200 individuals over a 40year period, and came to the following conclusions: ● Illness is associated with an increase in dream recall. ● Illness causes dreams to become stressful and nightmarish.

● ●

●

Stressful and nightmarish dreams generally appear before the first symptoms of an illness. Dreams caused by illness are longer than dreams caused by ordinary stress, and persist throughout the night and the duration of the illness. The content of the dream can reveal the location and seriousness of the illness.

See also Chapter 4, “Excessive Dreaming”, page 74. Among the various descriptions and traditions of dreams mentioned in Chapter 5, three types are particularly important to healing: ● Releasing dreams—the individual simply gets rid of suppressed emotions by experiencing them in a dream scenario. ● Teaching dreams—the individual gains insights into their psycho-emotional patterns. ● Healing dreams—the mind regains the power to readjust or heal the body. Numerous studies on the mind–body connection have been conducted in recent decades demonstrating that imagery and visualization have some definite physiological responses in the body, not unlike the psycho-physiological changes brought about by some dreams (Pannier 2006). According to Belleruth Naparstek, the main operating principles underlying visualization are as follows (Naparstek 1995): ● The body does not discriminate between sensory images in the mind and what is considered to be reality. ● In a relaxed, meditative state, the body is capable of more rapid and intense healing, growth, learning, and change. ● Imagery and visualization work helps individuals feel better about themselves because they have a sense of mastery over what is happening to them. Those who are better able to believe that they can cope with problems tend to have better treatment outcomes. However, visualization practices have limitations, for instance when there is some form of resistance or when the patient: ● Is unable to relate to the imagery or to visualize situations ● Is unable to focus and concentrate ● Is fixated on how things are, that is, the disease, rather than the desired outcome

Appendix 2

● ● ●

Is not able to involve all the senses Is not able to feel the visualization in the body Gives more credibility to the external reality than to internal healing powers

Dreams provide dreamers with images that are deeply meaningful to them, using symbols that they can relate to and accept without resistance. Therefore, combining these personal dream images with an adapted visualization method has a much stronger impact on the individual. The ideal dream therapy would thus enable the patient to engage in lucid dreaming (see below), during which the consciousness shen would direct the hun to the content and the unraveling of the dream (see Chapters 2 and 5).

●

●

●

Lucid Dreaming Lucid or conscious dreaming is a dream state during which the dreamer is aware that he or she is dreaming and can therefore control the dream to a certain extent. In the lucid state, the subject is able to confront threats and, as a result, to become more self-confident and to overcome fears and anxiety. This state of lucidity can be used as a tool to improve skills, to prepare for upcoming challenges, to fulfill fantasies, or to solve problems. There are two types of lucid dream: ● A dream-initiated lucid dream (DILD) starts as a normal dream during which the dreamer realizes that it is a dream. ● A wake-initiated lucid dream (WILD) occurs when the dreamer goes from a normal wakefulness directly into a dream state, with no apparent change in consciousness level. Lucid dreaming has been subjected to scientific research, and its existence is now well established (LaBerge 1990, Watnabe 2003): ● Many aspects of brain activity during the dream state are the same as during waking. What is learned or practiced in a lucid dream state is similar to the type of training and preparation undergone in the waking state. ● At least half of all adults have had one lucid dream in their lifetime, and many have reported having lucid dreams without even trying (Snyder and Gackenbach 1988). Flying is often associated with lucid dreams. With prac-

tice, lucid dreaming can be learned and practiced at will (LaBerge and Levitan 1995). As Pert’s research demonstrated, emotions impact the body’s physiology (Pert 1999). Therefore, transforming nightmarish images into positive, healing images can change the messages sent to the immune system. During dreams, one can bypass conscious resistance and the normal waking logic to allow limbic system logic to take over and change the image. As the limbic amygdala responds to perceptions, one can change the body’s physiology by changing these perceptions. Dream Yoga has been practiced by Tibetan Buddhists since the 8th century CE. During Dream Yoga, full waking consciousness is maintained while in the dream state (Mullin 1997). Without regular practice, lucid dreaming is sporadic and not easy to enhance at will. From a practical point of view, this means that when a patient is unable to have lucid dreams, the therapist, based on the assessments made of the patient’s dream imagery, can propose a combination of active visualization and guided suggestions. The positive images then reinforce the messages sent to the amygdala, which in turn stimulate the body’s healing process (Colic 2007).

Dream Analysis One has to be careful not to use dream dictionaries as a trustworthy source for interpreting one’s dreams. Each dream, like each individual person, is unique. Symbols—the language of dreams—may be universal, but, depending on one’s culture and conditioning, they do not always represent the same thing. A dog means something different to someone who dislikes or even hates dogs than it does to someone who loves them. Thus, the personal associations with the subject of the dream are much more meaningful than any information a dream dictionary might provide. Acquiring the ability to interpret dreams is a powerful tool for learning about deep secrets and hidden feelings. Dream dictionaries can, at most, inspire one to explore one’s dreams and offer a starting point for understanding them. When analyzing dreams, every detail, even the most trivial symbol, can be significant and must

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be considered. Each symbol represents a feeling, a mood, a memory, or something from the unconscious. One should look closely at the characters, animals, objects, places, emotions, and even colors and numbers that are depicted in one’s dreams. As with dream dictionaries, great care and discernment are required when referring to any systems in which different body parts or different diseases are related to specific psycho-emotional patterns. This same caution should be taken when approaching Chinese medicine. For example, a disease located in the lumbar or knee area relates to a kidney disharmony pattern. Since the kidneys react to fear, it is sometimes assumed that lumbar pain signifies a fear of change, and knee pain means a fear of death. But every person is unique, and consequently every illness and symptom has a different significance. The therapist has to be able to evaluate the significance of a given symptom in relation to the patient’s life context and avoid systematic labeling and categorizations. Louise Hay’s book You Can Heal Your Life contains a chapter in which she classifies physical problems and body parts, indicating the cause of a problem and providing new positive affirmation for healing (Hay 1999). In my opinion, such classification is very limiting and can lead to false beliefs about the cause and cure of a disease when used by a patient without the support of an adequately trained professional. This type of general classification can easily mislead patients and deny them the opportunity to undergo their own process of self-discovery. I am much more interested in the hidden roots of disease and in getting involved with the patient’s hidden processes, their personal feelings, and interpretations. Dream symbolism and dream work in a therapeutic setting are extremely useful for this purpose.

Integrating Dream Work into an Acupuncture Session I work with dreams in two ways. One way is to get participants to share their dreams in a workshop setting. Here, the vision and the input from others bring about a change in perspective for the dreamer and opens up new possibilities. The second way is to get participants to explore their dreams or hidden issues through clay modeling or water

painting (painting on wet paper, a variant of the lavis technique). Otherwise, most dream work is done in one-to-one sessions. During the initial consultation, patients are instructed in how to increase their capacity to recall dreams and how to keep a dream journal. Methods for recalling dreams: ● Self-suggestion in the morning and in the afternoon: “I will remember my dreams at night” ● Self-suggestion in the evening before going to sleep: “Soon dreams will be coming and I will remember them in the morning” ● Having a pen and writing pad at the bedside ● Keeping a dated dream journal ● When possible, painting or drawing some part of the dream image In follow-up sessions, after the acupuncture needles have been removed, the therapist helps the patient into a guided fantasy. The theme of this fantasy is inspired by the most relevant dreams and patterns that the patient has shared with the therapist. The therapist’s aim is to guide patients in exploring some of their issues more deeply, especially to replay scenes in a manner in which patients are empowered and can face and deal with the fears and dangers encountered in the dream. The following aspects are important when doing this kind of work: ● The therapist should adopt a receptive rather than a directive attitude, without making any judgments. ● The integrity of the dream and the dreamer should be kept intact. A very useful sentence when making suggestions about the meaning of someone’s dreams is: “If this were my dream or my creation... .” This acknowledges that anything one says about someone else’s dream or creation will be one’s own projections. ● It should be focused on what the patient is actually experiencing and feeling rather than on objective facts, general considerations, or symbolism. The therapist should keep a compassionate attitude without becoming emotionally involved. Not getting fixated on the specific problem allows the therapist to see the context from the patient’s point of view. ● The therapist should respect the patient with authenticity and understanding, without prejudice, judgment, solutions, and manipulation.

Appendix 2

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The dream and the dreamer have to be respected. The creator of the dream better understands the meaning of their dreams. Also, the limits a patient might set have to be respected. Clear and respectful communication should be facilitated. This means that the therapist should help the patient to understand unconscious messages rather than interpreting them or providing ready-made solutions and advice. Patients know better than anyone what their problems are, and they can find their way to healing and what they need. The main mistake in trying to help is to believe that we understand what another person is telling us, when in fact we are interpreting or projecting our own ideas onto the situation.

●

Heart-to-heart communication is very important in healing so as to stay in contact with the deeper self, from where all profound transformations arise.

Therapists have to remember that patients can overcome their obstacles, and that they have all the resources they need for doing just that. Heart-to-heart communication is essential for keeping the atmosphere of equality that is fundamental between two persons, even though one is directing the healing and the other is receiving it. Treatment or healing is a sharing experience. It is a sharing between two human beings who are searching and suffering. One of them plays the role of the giver, and the other the role of the receiver and reciprocates.

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Glossary of Chinese Terms Used in the Book

Pin yin

English

Chinese

An

Calm, quiet, peace

安

An Mian

Peaceful sleep

安眠

Chong Mai

Penetrating vessel

衝脉

Da Chang

Large intestine

大肠

Dai Mai

Belt / girdling vessel

带脉

Dan

Gallbladder

胆

Di

Earth, soil

地

Ding

Settle, stabilize

定

Du Mai

Governing vessel

督脉

Fan

Restlessness/vexation

烦

Fei

Lung

肺

Gan

Liver

旰

Gu

Bone

骨

Gui

Ghost, unnamed spirit, demon

鬼

He

Sea

合

Huang

Vital membranes

肓

Hun

Ethereal soul

魂

Jin

Sinews, muscles

筋

Jing

River, channel

经

Jing

Well

井

Jing Bie

Divergent channels

经別

Jing Jin

Sinew, tendino-muscular channels

经筋

Jing Qi

Essence, essential qi

精气

Jue Yin

Terminal yin

厥陰

Kuang

Mania

狂

Lao

Taxation

劳

Ling

Soul, spirit

靈

Luo

Connecting

絡

Luo Mai

Connecting/network channels/vessels

经脉

Mai

Vessel, channel

脉

Ming

Destiny, life, mandate

命

Mu

Collecting point

募

Nao

Brain

脑

Pang Guang

Bladder

膀胱

Glossary of Chinese Terms Used in the Book

Pin yin

English

Chinese

Pi

Spleen

睥

Po

Corporeal / animal soul

魄

Qi

Qi

气

Qi Jing Ba Mai

Eight extraordinary vessels

奇经八脉

Qing

Clear, quiet

清

Ren Mai

Conception vessel

任脉

San Jiao

Triple burner / triple warmer

三焦

Shao Yang

Lesser yang

少陽

Shao Yin

Lesser yin

少陰

Shen

Kidney

肾

Shen

Spirit, consciousness, intelligence, mind, emotions

神

Shi

Repletion, excess

实

Shu

Stream

俞

Shu / bei shu

Transport point / back transport

俞/背俞

Sui

Marrow

髓

Tai Yang

Supreme yang

太陽

Tai Yin

Supreme yin

太陰

Tian

Heaven

天

Tian chuang

Window of heaven/sky

天窗

Tu

Earth phase

土

Wei

Stomach

胃

Wei Qi

Defensive qi

卫气

Wu Xing

Five moving forces, five phases

五行

Xi

Cleft/accumulation

郗

Xiao Chang

Small intestine

小肠

Xin

Heart

心

Xin Bao

Pericard

心包

Xu

Vacuity, deficiency

虛

Xue

Blood

血

Yang Ming

Yang brightness

陽明

Yang Qiao Mai

Yang motility / stepping vessel

陽蹻脉

Yang Wei Mai

Yang binding / linking vessel

陽維脉

Yi

Intellect, thought, intention

意

Yin Qiao Mai

Yin motility / stepping vessel

陰蹻脉

Yin Wei Mai

Yin binding / linking vessel

陰維脉

Ying

Spring

滎

Ying Qi

Nourishing energy

營气

Yuan

Source

原

Zang Fu

Viscera and bowels, yin and yang organs

脏腑

135

136

Appendices

Pin yin

English

Chinese

Zao

Mental agitation / irritability

躁

Zheng Jing

Primary channels

正经

Zhi

Will power

志

Zi Gong / Bao

Uterus

子胞/包

137

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Personal Communications Dr. Michel Frey, MD, is a specialist in acupuncture, ethnomedicine, and PMA (Procréation Médicalement Assistée). He is the president of Conseil Supérieur National d l’Acupuncture Traditionnelle, and Founding Director of the Ecole d’Acupuncture Traditionnelle. Publications bearing his name include: Mieux vivre grâce à la médecine chinoise (Le Pré aux Clerks, 2007); Yin Yang, Faites un bébé zen avec la médecine chinoise (Médicis, 2004); 150 maladies, 600 remèdes (France Loisirs; 2009); and L’acupuncture, comprendre cette médecine (Librairie You-Feng, 2010). Dr. Kamran Ghaffari, MD, FRCPsych, is a psychiatrist specializing in cognitive behavior therapy and currently practices in Zurich, Switzerland. He is also the author of The Function of Assessment Within Psychological Therapies: A Psychodynamic View (Karnac, 2004). Dr. Gerald Langel, MD, is the Founding Director and Senior Medical Officer of the Centre d’Analyse et d’Investigation du Sommeil, a sleep specialist, and co-author of the study project on Acupuncture and Insomnia.

Roland Solère is an acupuncturist and osteopath, codirector of the Ecole d’Acupuncture Traditionnelle), and originator of the Functional Reequilibration Method. Master Jeffrey C. Yuen is an 88th-generation Master of the Yu Qing Huang Lao Pai (Jade Purity Yellow Emperor Lao Zi School) ordained by Master Yu Wen, and 26th generation of Quan Zhen Long Men Pai (Complete Reality Dragon Gate School) ordained by Master Lu Xin Xu. Involved in the study of Daoism and the classics of Chinese medicine since early childhood, Master Yuen is very active in the fields of TCM, Daoism, qi gong, and tai chi, and is currently the chairman of the Eastern United States Taoist Association and the president of the International Tai Chi Institute, besides being an adviser on the board of numerous other institutions. His input on dream analysis was an invaluable addition to Chapter 5, with references and commentaries to Chen Shi Yuan’s work, the Meng Zhan Yi Zhi (Analysis and Conclusion of Dreams) (1562), a text that has not yet been translated.

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Index Page numbers in italics refer to illustrations or tables

A abdominal masses 66 abdominal pain 74 acne 38, 69, 79 activation synthesis dream theory 7, 96, 97 addictions 50 adenosine 5 agitation 20, 38, 43, 48, 68–69, 79, 124 alcohol 12 allergy 42 amenorrhea 50 amnesia 41, 72 amphetamines 12 an mian 13 anger 37, 40–42, 68, 76, 78, 84 angina 36, 66, 68–69, 72, 79 anuria 42 anxiety 35–36, 39–43, 50–51, 68–69, 78–81, 84, 124 apathy 66, 71, 73–74, 82 appetite loss 36, 66, 71, 74, 76, 78, 80, 83, 101 jet lag and 84 arthralgia 43 asthma 32, 38, 50, 74, 81 auriculotherapy see ear acupuncture

B barbiturates 12 benzodiazepines 12 bitter taste 35, 37, 68–69, 76, 78, 81, 84 bladder 22 damp–heat 74 qi vacuity 100 bladder (zu tai yang) channels 46–47 bloating 30–31, 38, 66, 69, 71, 74, 83 blood (wei qi) 19–20 circulation 14–16, 15 disorders 35

heat 20 liver blood not nourishing the kidney jing 102 stagnation 20 stasis 68, 69, 72, 79 heart 36, 68, 69, 79 liver 105 upper body 66 vacuity 20, 32, 66 case study 56–57 heart 36, 58–59, 68, 75, 79, 81 liver 37, 40, 58–60, 68, 79, 82–83, 105 blurred vision 36, 42, 65–66, 68, 71, 75, 80–81 brain development 2 bruxism (tooth grinding) 10, 30–31, 35, 74, 126 Buddhist tradition 90, 99

C caffeine 12 calm insomnia 20 Chen Shi Yuan 92–93 chest oppression 34, 36, 38, 42– 43, 51, 66, 68, 71, 76, 78, 80, 82 chest pains 36, 66, 68–69, 72, 79 chong mai 22, 23, 24 insomnia and 42 chronobiological disorders 10, 84–88 chronotype 5 circadian rhythm 4–5, 5 desynchronization 84–88 sleep disorders 5, 84–88 case studies 54, 55–56 situational 10 see also jet lag; shift work clock protein 4 cocaine 12 colds 38, 74, 81 Confucianism 92, 99 confusion, jet lag and 84 congestion 36, 84 consciousness 20, 20

constipation 74 continual-activation dream theory 7, 97, 97 convulsions 37, 42, 49 infantile 48 correspondence system 18, 19 cosmogenic order 18, 19 cough 38, 74, 81 craving 41

D dai mai 22, 23 insomnia and 42 damp–heat 38 bladder 74 lower burner 74 triple burner 37 danger, dream interpretations 101–103 Daoist tradition 91–92, 98, 99 Darwinian random though mutations 7 deafness 37, 43, 73 depressants 12 depression 36, 39–41, 43, 50, 66, 68–69, 71, 74, 82 dermatitis 50 developmental dreams 95, 96 diarrhea 43, 71, 73, 82 dietary advice 52, 53 digestive problems 50 dimethyltryptamine (DMT) 7 discontentment 124 dizziness 36–37, 42, 48–49, 66, 68, 71–72, 75–76, 78–82, 84 dong qi 22, 22 dreams 6–7, 21, 36–38, 51, 124, 126 as reality 98–99 brain activity during 8, 8, 9, 75, 94–95 classification 96–97 developmental dreams 95, 96 dream analysis 131–132 dream theories 7–8

Index

Buddhist tradition 90 Chinese tradition 90–95 Greek mythology 89 Hindu traditions 89 Middle Eastern traditions 89 modern dream theories 94–95, 95 emotional effects 75, 129–130 excessive dreaming 74–76, 79, 81–82, 124 explanation 74–75 influencing factors 93–94 interacting dreams 95–98, 96–97 interpretations and therapeutic strategies 101–106 dreams of control/direction/ movement/navigation 104–105, 106 dreams of fear/danger/threat 101–103, 106 dreams of home/property/ territory/boundaries/ valuables 103–104, 106 dreams of night terrors/ghosts 105–106, 106 dreams of vulnerability/ exposure 105, 106 importance of 106–108 lucid dreaming 90, 91, 98, 131 of falling 81–83 explanation 81–82 of flying 35–36, 68–69, 75–76, 78, 80–81, 84 explanation 80–81 physiological effects 75 psychotherapy and 130–131 sexual 82–84, 124, 126 explanation 83 significance of 99–101, 107 sleep-talking and 69 sleep-walking and 67, 68 transformational dreams 97, 98 working with 129–133 drug addiction 50 dry mouth 35, 74, 125 dry skin 37–38, 76, 79, 81 dry throat 36–38, 76, 79, 81, 84 du mai 22, 23 insomnia and 42, 48 dysmenorrhea 50 dyssomnia 9–10

E ear acupuncture 50–51 jet lag treatment 86, 86 ear blockage 32 earth phase pathologies 38 eczema 43, 50 edema 50, 71, 73, 82 jet lag and 84 embarrassment 125 embryo 90 emotional selection theory 7, 95, 96 emotions 21, 39–40 dreaming and 75 emotional restlessness 35 insomnia treatment and 40–42 releasing 40–41 energy drinks 12 enuresis 35, 72–74, 124 case study 61–62 explanation 72 envy 37, 68, 76, 78, 84 epilepsy 42, 49, 50 excitability 42 exercises 51–52 exophthalmia 42 exploding head syndrome 10 extraordinary vessels 14, 22–23, 23 eye symptoms 37, 42–43, 48–50, 68–69, 79 floaters 82 red eyes 38

F fan (vexation) 20, 37–38, 68 fatigue 36–39, 66, 69, 74, 76, 79, 82–83 jet lag and 84 mental 66, 71, 73, 82 fear 41–43, 50, 73, 77, 82, 125 case studies 54–55, 64 dream interpretations 101–103 of change 40 fetus 90 fever 42, 43 tidal 34 fire heart 35, 40, 41, 42, 69, 78, 81 liver 37, 41, 68, 76, 78, 84 case study 60 phlegm 36, 68, 76, 78, 80

stomach, case study 60–61 fire phase pathologies 35–37 five elements 18, 19 “five palm” heat 36, 38, 76, 84 five wills 39 food stagnation 69–70 forgetfulness 65–66, 71, 73, 82– 83 Freud, Sigmund 94 frustration 40, 41 fu (bowels) 22 fulfilment dream theory 8, 97–98, 97

G gallbladder 22 qi vacuity 37–38, 76, 79, 82, 100 gallbladder (zu shao yang) channels 47 gastritis 38, 79 gates 90–91 ghost points 128–129 Greek mythology 89 grief 40–42 growth hormones 2 gui 18 guilt 125

H halitosis 38, 69, 79 hate 41 headaches 37, 42–43, 49, 65–66, 68, 72, 76, 78–81, 84 jet lag and 84 morning 71 heart 20, 21, 40 blood stasis 36, 68, 69, 79 blood vacuity 36, 68, 75, 79, 81 case study 58–59 fire 35, 40, 41, 42, 69, 78, 81 out of harmony 76, 84, 102–103 pain 37, 43, 84 phlegm harrassing the heart 106 qi repletion 100 qi vacuity 36, 76, 79, 82, 83, 100 will of 39 yang vacuity 36, 39, 68–69 yin vacuity 36, 38–39, 76, 84

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Appendices

heart diseases 35, 68, 69 heart (shou shao yin) channels herbal teas 52 Hindu traditions 89 hip pain 42 horary points 86–87, 87 HT-7 shen men 44 HT-8 shao fu 44 hun 16, 18–20, 18, 21, 39, 40 dreaming and 75, 93, 94 hunger 38, 79 hypertension 35, 37, 48, 50, 68–69, 84 hypopnea syndrome 10 hypotension 43 hysteria 41

44

I immune function 1 impotence 42 incontinence 73–74 insomnia 10, 11–12, 29–64, 29, 76, 79, 82, 124, 125 calm insomnia 20 case studies 53–64 causes 12, 29 clinical studies 109–121 methodology 110–111 patients 109–110 results 111–119 diagnosis 30–32 jet lag and 84 treatment 32–53 ear acupuncture 50–51, 50 emotions and 40–42 exercises (qi gong) 51–52 extraordinary channels and 42–43 in Western medicine 12 movement of blood disorders 35 movement of wei qi disorders 32–35, 33, 34 overview of treatment strategies 52–53 point combinations 51 seasonal desynchronization 43 zang fu pathologies 35–39 insomnia-1 point 50–51, 50 insomnia-2 point 50–51, 50 integrating dreams theory 96, 97 interacting dreams 95–98, 96–97

internal wind 37, 42, 68 irritability 35, 37, 40–42, 68, 74, 76, 78–82, 84 itching 35

J jealousy 37, 68, 76, 78, 84 Jenkins Sleep Questionnaire 112, 115 jet lag 32, 52, 53, 84–87, 125 explanation 84–85 prevention 86–87 treatment 85–86 ear acupuncture 86, 86 jing bie 65 joy 42 Jung, Carl Gustav 94

K kidney 22–23 dream interpretations and 101–103 kidneys not grasping lung qi 102 liver blood not nourishing the kidney jing 102 out of harmony 76, 84, 102–103 qi repletion 100 qi vacuity 40, 43, 73, 82, 100, 102 will of 39 yang vacuity 39, 68–69, 71, 73, 82, 102 yin vacuity 36, 38–39, 43, 76, 84 kidney (zu shao yin) channels 44

L large intestine 22 qi vacuity 100 large intestine (shou yang ming) channels 46 libido, weak 73, 82 life curriculum 90–91, 98 life cycles 90–91 light therapy 52 Ling Shu 91 liver 20, 21, 91 blood stasis 105 blood vacuity 37, 40, 68, 79, 82–83, 105

case studies 58–60 dream interpretations and 104–105 fire 37, 41, 68, 76, 78, 84 case study 60 qi repletion 100 qi stagnation 84, 104–105 qi stasis 68, 82–83 qi vacuity 100 case study 58–59 symptoms 68 will of 39 wind 81 yang rising 79, 81, 105 yin vacuity 37, 76, 79, 81 liver (zu jue yin) channels 44–45 longevity related to sleep time 6 lucid dreaming 90, 91, 98, 131 lumbar pain 36, 38–39, 42–43, 66, 69, 71, 73, 76, 82, 84 lung heat 38 qi repletion 100 qi vacuity 38, 74, 81, 100, 105 will of 39 yin vacuity 105 lung (shou tai yin) channels 45 luo (connecting channels) 16, 41 bleeding 41

M manic behavior 41, 78 master Omega point 50, 50 Medical Outcomes Study (MOS) Energy and Fatigue module questionnaire (MEF) 112, 115 Sleep module questionnaire (MS) 112, 115 melatonin 85 memory 2 dreams and 7 excitations of long-term memory 97, 97 impairment 36, 41, 66, 79, 101 memory consolidation dream theory 97, 97 menopausal syndrome 34 menstrual problems amenorrhea 50 menstrual cycle 42, 68, 83 painful periods 66, 72 mental activity 17, 17, 20, 30 dreaming and 8, 8, 9, 75, 94–95

Index

restlessness 35, 41, 84, 125 mental fatigue 66, 71, 73, 82 mental relaxation 16–17 mental schemata, testing and selection 7 metal phase pathologies 38 midday–midnight clock 85 Middle Eastern traditions 89 ming 90, 91 mood-regulating dream theory 96, 98 muscle cramps 35 muscle tension 35, 50

N narcolepsy 10, 65 nausea 36, 42, 66, 68–69, 71, 76, 78, 80 jet lag and 84 neck stiffness 42 neck tension 31, 35 Nei Jing 91 nervousness 37, 39, 49–50 neuralgia, facial 43 night sweating 34–36, 38, 76, 84 night terrors 10, 76–77, 79, 125 case studies 61–62, 63–64 explanation 79 nightmares 29, 31–32, 35–38, 41, 51, 74–82, 84, 126 case studies 57–58, 60, 61–62 dream interpretations 101–103 explanation 77–78 sleep-talking and 69 sleep-walking and 68 nighttime food cravings 31, 35 nighttime thirst 35 nocturia 10, 53, 72–74, 126 explanation 72–73 nocturnal emission 83 noetic theory 99 non-rapid eye movement (non-REM) 2, 10, 69, 77, 80 nose bleeds 42 nose blockage 32 numbness 79

O obesity 38, 50, 71, 80 obsessions 40–41, 50, 126 obstructive sleep apnea 10, 32, 34, 70

case study 62–63 oneiric Darwinism 95, 96 otitis 43 overexcitement 37, 41, 84 oversensitivity 43

P pain 42, 43, 50 abdominal 74 chest 36, 66, 68–69, 72, 79 heart 37, 43, 84 hip 42 lumbar 36, 38–39, 42–43, 66, 69, 71, 73, 76, 82, 84 palpitations 36–39, 43, 49, 66, 68–69, 75–76, 78–79, 81–84 panic attacks 42, 101 paralysis 42 parasomnia 10 Parkinson’s disease 42 parotid its 43 pen points 86–87, 87 pericardium heat 84 qi repletion 36 qi vacuity 36 pericardium (shou jue yin) channels 44–45 periodic limb movement disorder 10 Pert, Candace 95, 129 phlegm accumulation 105–106 fire 36, 68, 72, 76, 78, 80 harrassing the heart 106 misting the mind 66, 71, 80, 105 phototherapy 52 placebo effects 109 po 18–19, 93, 94 polysomnography 4, 111–112 positron emission tomography (PET) 8 premenstrual breast distension 68, 83 premonitory dreams 98 processing dreams 98 pruritis 29, 31, 42, 49, 50 psychosis 49, 65 psychosomatic dream theory 7–8, 96, 98 ptosis 43 pulse 35–39, 66–69, 71–76, 78– 84

Q qi

108 circulation clock 85, 85 repletion 41 heart 100 kidney 100 liver 100 lung 100 pericardium 37 sinking, spleen qi 104 stagnation, liver 84, 104–105 stasis, liver 68, 82–83 vacuity 40 bladder 100 gallbladder 37–38, 76, 79, 82, 100 heart 36, 76, 79, 82, 83, 100 kidney 40, 43, 73, 82, 100, 102 large intestine 100 liver 58–59, 100 lung 38, 74, 81, 100, 105 pericardium 36 small intestine 100 spleen 38, 40, 53, 59, 71, 74, 83, 100, 103 stomach 100 Qi Bo 99–100 qi gong 51–52

R rapid eye movement (REM) sleep 1, 2, 4, 21 brain development and 2 ultradian rhythm 5 Raynaud disease 50 reality 98–99 rebound phenomena 12 releasing dreams 96, 97 REM see rapid eye movement (REM) sleep REM sleep behavior disorder 10 ren mai 22, 23, 24, 101 insomnia and 42, 48 restless legs syndrome (RLS) 10, 29–31, 35, 126 restlessness 20, 30, 35–38, 48, 50, 68, 75–76, 78–82, 84, 126 mental/emotional 35, 41, 84, 125 retardation 41 reverse learning theory 96, 97

147

148

Appendices

“running piglet” syndrome 101

42,

S sadness 40–42, 81 Seven Dragons 129 sexsomnia 10 sexual dreams 82–84, 124, 126 explanation 83 sexual dysfunction 37 sexual perversions 37, 84 shen 16–17, 19–20, 39, 40, 108 calming 41–42 shen men 50, 50 shi shui 65–67 shift work 32, 52, 87–88 case study 54 shock 72 shortness of breath 36–37, 39, 66, 69, 76, 79, 82–83 shoulder tension 35 shu points 40–41 SI-3 du mai 46 sinusitis 43 skin hyperesthesia 43 sleep 1, 43 amount of 5–6, 6 associated physiological processes 1–2 anabolism/somatic growth 2 brain development/ ontogenesis 2 memory 2 restoration/rejuvenation 1 circadian rhythm 4–5, 5 consequences of inadequate sleep 6 evaluation 111 in Chinese medicine 13–27, 28 organization 24–25 stages 2–4, 3 ultradian rhythm 5 sleep apnea 10, 29, 31, 70–72, 80 explanation 70–71 obstructive 10, 32, 34, 70 case study 62–63 sleep debt 1 sleep deprivation studies 1 sleep disorders 9–11 circadian rhythm disorders 5, 84–88 case studies 54, 55–56 situational 10

classification 11 dyssomnia 9–10 parasomnia 10 secondary disorders 10 see also specific disorders sleep paralysis 10 sleep sex 10 sleep spindles 4 sleep-talking 10, 29, 31, 37, 51, 69–70, 76, 79, 81, 126 explanation 69 sleep-walking 10, 29, 31, 37–38, 49, 66–69, 76, 79, 81–82, 126 case studies 57, 60–61 explanation 67 sleepiness 65–67, 71, 80, 82–83, 126 see also somnolence small intestine 22 qi vacuity 100 small intestine (shou tai yang) channels 46 snoring 29, 31–32, 34, 36, 38, 53, 66, 76, 78, 80 case study 62–63 sleep apnea and 70, 71 somnambulism see sleep-walking somnolence 65–67 space 25, 26–27, 26 spasms 37, 43, 50 spermatorrhea 42, 83, 126 spleen 20 dream interpretations and 103–104 qi sinking 104 qi vacuity 38, 40, 71, 74, 83, 100, 103 case studies 53, 59 vacuity with dampness 104 will of 39 yang vacuity 71, 73, 82 spleen (zu tai yin) channels 45 sputum 66, 71, 80 steaming bone syndrome 34 sterility 42 stimulants 12 stomach 22 fire, case study 60–61 heat 38, 79 hyperacidity 50 qi vacuity 100 stomach (zu yang min) channels 46 stress 50 stroke 49, 66, 72

suprachiasmatic nucleus (SCN) 85 sweating 66, 71

4,

T tachycardia 35, 50, 68–69, 84 thirst 38, 74, 79, 84, 125 nighttime 38 threat, dream interpretations 101–103 tics 37 tidal fevers 34 time 25, 26 tinnitus 36, 38, 42–43, 48, 66, 73, 76, 79, 84 tongue 35–39, 66–69, 71–76, 78–84 ulceration 35, 69, 78, 81 tooth grinding (bruxism) 10, 30– 31, 35, 74, 126 tranquilizer/relaxation point 50, 50 transformational dreams 97, 98 trauma 66, 72 trembling 37 triple burner 22 damp heat 37 triple burner (shou shao yang) channels 47 tumors 72

U ultradian rhythm 5 urination, frequent 67, 69, 71, 73–74, 82 urogenital problems 50

V vascular diseases 50 vertigo 50 vomiting 42

W water phase pathologies 38–39 weakness 42, 66, 83 wei qi circulation 14–16, 15, 16, 21, 22 disorders 32–35, 33, 34 whiplash injury 66 wills 39

Index

Window of the Sky points 65 wood phase pathologies 37–38 worry 40–42, 50, 81, 126 case study 53 wound healing 1 wu ji (four seasons) 18 wu xiang (five directions) 18 wu xing correspondence system 18, 19

X xie qi 100–101 xue 19–20

Y yang 13–14, 13, 14, 25 liver, rising 79, 81, 105 organization 23, 24, 26 repletion 42, 99, 100

spatial distribution 26–27, 27 stasis 42 vacuity heart 36, 39, 68–69 kidney 39, 68–69, 71, 73, 82, 102 spleen 71, 73, 82 yang qiao mai 23, 24, 25, 26 insomnia and 42–43 symptoms 24 yang wei mai 23, 25 insomnia and 43 symptoms 24 yi 17–18 yin 13–14, 13, 14, 25 accumulation 65 organization 23–24, 24, 26 repletion 65, 99, 100 spatial distribution 26–27, 27 temporal movements 26, 30 vacuity 42

heart 36, 38–39, 76, 84 kidney 36, 38–39, 43, 76, 84 liver 37, 76, 79, 81 lung 105 yin qiao mai 23, 25, 25, 26 insomnia and 42 symptoms 24, 31 yin tang 48 yin wei mai 23, 24, 25, 27, 27, 102 insomnia and 43 symptoms 24–25, 31, 32

Z zang fu vacuity 100 zang zao 19–20 zao (agitation) 20 zhi points 40–41 Zhuang Zi 92

149